Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1013342740 |
---|---|
Provider Name | Ms. Kelly Ann Flood |
First Address | Portland, OR 97202-3371 |
Second Address | Portland, OR 97202-3371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2013 |
Last Update Date | 12/09/2013 |