Provider Demographics
NPI:1205692191
Name:TOMPKINS, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:SOLUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1952 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1952 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1304
Practice Address - Country:US
Practice Address - Phone:503-726-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty