Provider Demographics
NPI:1639144181
Name:SANDERS, KIMBERLY BIGGS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BIGGS
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:C
Other - Last Name:BIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:CH16D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-418-3376
Mailing Address - Fax:503-494-6968
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:CH16D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-418-3376
Practice Address - Fax:503-494-6968
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004982363AM0700X
ORPA01062363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPA01062OtherPHYSICIAN ASSITANT
WAPA10004982OtherSTATE OF WASHINGTON
OR3265OtherLIMITED PERMIT
OR3265OtherLIMITED PERMIT
WAPA10004982OtherSTATE OF WASHINGTON
WAG8859070Medicare PIN