Provider Demographics
NPI:1972548865
Name:FELDER, KIMBERLY KAY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAY
Last Name:FELDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:SILVERNAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD. L457
Mailing Address - Street 2:OREGON HEALTH SCIENCE UNIVERSITY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-9444
Mailing Address - Fax:503-494-4264
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD. L457
Practice Address - Street 2:OREGON HEALTH SCIENCE UNIVERSITY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-9444
Practice Address - Fax:503-494-4264
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00804363AM0700X, 363A00000X
ORORPA00804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104711Medicaid
ORORPA00804OtherOREGON BOARD OF MEDICAL EXAMINERS
131765Medicare PIN
C94402Medicare UPIN
00WCQKWCMedicare ID - Type Unspecified
OR104711Medicaid