Provider Demographics
NPI:1801443221
Name:LILLEY-KARKOS, KINDA (MA)
Entity type:Individual
Prefix:
First Name:KINDA
Middle Name:
Last Name:LILLEY-KARKOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KINDA
Other - Middle Name:
Other - Last Name:LILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18693 SW BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1285
Mailing Address - Country:US
Mailing Address - Phone:207-491-8763
Mailing Address - Fax:
Practice Address - Street 1:2222 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1365
Practice Address - Country:US
Practice Address - Phone:503-669-4300
Practice Address - Fax:503-669-4301
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program