Provider Demographics
NPI:1740498120
Name:KENNEY-MOORE, PATRICIA (MS, PA-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:KENNEY-MOORE
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24979 NE PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-9547
Mailing Address - Country:US
Mailing Address - Phone:503-678-5921
Mailing Address - Fax:
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant