Individual provider Active NPI

Kimberly J Wehbe, FNP

  • Family Nurse Practitioner
  • Portland, OR
National Provider Identifier
1477586097
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
99006597 Issued in OR
Practice address
4920 N Interstate Ave
Portland, OR 97217-3653
Phone
(503) 215-3300
Fax
(503) 215-3350
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 099006597N1 OR
Family Nurse Practitioner 363LF0000X 99006597 OR Primary

Addresses

Primary practice location

4920 N Interstate Ave
Portland, OR 97217-3653

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other identifiers 2

IdentifierTypeStateIssuer
291742MedicaidOR
P00214385OtherORRR MEDICARE

Electronic endpoints 7

TypeEndpointUseAffiliation
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org
Direct Messaging Address kwehbe117747@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040609001373 OR Practitioner - Nurse Practitioner 8628051778 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1321 NE 99TH Ave
Suite 200
Portland, OR 97220-9439
Phone (503) 215-4250

4400 NE Halsey St
Portland, OR 97213-1545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
099006597N1ORMDNurse Practitioner
99006597ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 1, 2022 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 1, 2020 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jun 1, 2022 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

12345 SW Horizon Blvd
Ste 57
Beaverton, OR 97007
Phone (503) 216-8820

9290 SE Sunnybrook Blvd
Ste 120
Clackamas, OR 97015
Phone (503) 215-2110

440 NW Division St
Gresham, OR 97030
Phone (503) 215-9500

5555 NE Elam Young Pkwy
Hillsboro, OR 97124
Phone (503) 216-1600

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

12442 SW Scholls Ferry Rd
Ste 100
Tigard, OR 97223
Phone (503) 215-9900

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1477586097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972173653",
            "telephone_number": "503-215-3300",
            "fax_number": "503-215-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEHBE",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "099006597N1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "99006597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291742",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00214385",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "200 S Hazel Dell Way",
            "city": "Canby",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970137829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1321 NE 99th Ave Ste 100",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972209437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12442 SW Scholls Ferry Rd Ste 100",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972230803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "16770 SW Edy Rd Ste 102",
            "city": "Sherwood",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971409679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "10670 NE Cornell Rd Ste 101",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971249221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "16180 SE Sunnyside Rd Ste 102",
            "city": "Happy Valley",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970156302",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwehbe117747@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12345 SW Horizon Blvd Ste 57",
            "city": "Beaverton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970079475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.