Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1620 | OR |
NPI | 1083881007 |
---|---|
Provider Name | Dr. Kelly Jennings |
First Address | Portland, OR 97206-1544 |
Second Address | Portland, OR 97206-1544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |