Provider Demographics
NPI:1780968784
Name:RICH, KIMBERLY (RN, GNP, FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:RN, GNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:9 KPV
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-418-4944
Mailing Address - Fax:503-494-2994
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:9 KPV
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-4944
Practice Address - Fax:503-494-2994
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150067NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily