Provider Demographics
NPI:1609234038
Name:STALLINGS, KELCEE
Entity Type:Individual
Prefix:
First Name:KELCEE
Middle Name:
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9861 SW 35TH DR
Mailing Address - Street 2:APT. 41
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6141
Mailing Address - Country:US
Mailing Address - Phone:318-801-9468
Mailing Address - Fax:
Practice Address - Street 1:4445 SW BARBUR BLVD
Practice Address - Street 2:SUITE #205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4047
Practice Address - Country:US
Practice Address - Phone:503-768-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program