Kimberly Dawn Payne, LMT
Individual provider Active NPI Specialist · Portland, OR
NPI 1790754372 · NPPES record last updated Nov 20, 2008
Key facts
- NPI
- 1790754372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 8152 (OR)
- Practice address
- 4475 SW Scholls Ferry Rd
Ste 201
Portland, OR 97225-1955 - Phone
- (503) 516-7938
- NPI assigned
- Mar 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8152 | OR | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 2 Frisky Dingos | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 8152 | OR | Yes |
Addresses
Primary practice location
4475 SW Scholls Ferry Rd
Ste 201
Portland, OR 97225-1955
Mailing address
4475 SW Scholls Ferry Rd
Ste 201
Portland, OR 97225-1955
Phone (503) 516-7938
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.