Kelly Washburn, Inc.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

KELLY WASHBURN, INC.

Practice address

5935 SE Belmont St
Portland, OR 97215-1925

Phone

(541) 638-0261

Fax

(833) 520-1522

NPI assigned

Feb 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Pondolfino

Title

Medical Office Manager

Phone

(971) 328-0083

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1003560517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5935 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151925",
            "telephone_number": "541-638-0261",
            "fax_number": "833-520-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5935 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151925",
            "telephone_number": "541-638-0261",
            "fax_number": "833-520-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY WASHBURN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "PONDOLFINO",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "MEDICAL OFFICE MANAGER",
        "authorized_official_telephone_number": "971-328-0083"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500689145",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Kellogg
• Marissa Anne Kellogg, MD, MPH
• Kelly Prill Naturopathic Physcian, LLC (Elemental Wellness)
• Kelly Raylinsky
• Kelly Selis, LCSW
• Kirsten Kelly-Chambers
• Nancy Kelly-Culberson, CRNA
• Amy Kelly
• Anabel Elizabeth Kelly, RN
• Aubrey Kelly, L.AC

• Adult Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.