Provider Demographics
NPI:1770282055
Name:KAILIN, DACIA RENEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DACIA
Middle Name:RENEE
Last Name:KAILIN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 NE MARY ROSE PL STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7133
Mailing Address - Country:US
Mailing Address - Phone:541-585-7546
Mailing Address - Fax:
Practice Address - Street 1:2450 NE MARY ROSE PL STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7133
Practice Address - Country:US
Practice Address - Phone:541-585-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical