Kimberly Starr Waldrep, FNPC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201500630NP-PP Issued in OR

Practice address

1804 SE Spokane St
Portland, OR 97202-6742

Phone

(503) 997-9152

NPI assigned

Feb 6, 2013

Last updated

Mar 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.waldrep.1@21026.direct.athenahealth.com

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

• Hudson's Bay Medical Group, Inc., P.S.

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1942204664

  Family Medicine

  Medicare reassignment NPD
• Oregon City Medical

  • Family Medicine Physician
  • Oregon City, OR
  • NPI 1699943167
  NPD (past)

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

{
    "created_epoch": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1538408844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 MOLALLA AVE",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970452799",
            "telephone_number": "503-656-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 SE SPOKANE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972026742",
            "telephone_number": "503-997-9152"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "728 Molalla Ave",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970452799",
            "country_code": "US",
            "telephone_number": "503-656-9030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDREP",
        "first_name": "KIMBERLY",
        "middle_name": "STARR",
        "credential": "FNPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201500630NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Anne Waldorf, MD
• Lawrence Waldorf
• Grace Waldow, MS
• Joseph Patrick Waldram, M.D.
• Stephen Earl Waldram, DMD
• Alexandra Elizabeth Waldron, MD
• Ashley Lynn Waldron, MS-SLP
• Brent Waldron
• Emily Ann Waldron, MSW
• Sheena Waldron

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.