Kimberly Ann Jacoby, PNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

202100947NP-PP Issued in OR

Practice address

1425 Beavercreek Road
Oregon City, OR 97045-4023

Phone

(503) 655-8471

Fax

(503) 655-8595

NPI assigned

Aug 30, 2012

Last updated

Feb 24, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1821347311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 N BIRCH ST",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970133326",
            "telephone_number": "503-341-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 BEAVERCREEK ROAD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454023",
            "telephone_number": "503-655-8471",
            "fax_number": "503-655-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "202100947NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isd Renal Inc (Willamette Valley Renal Center)
• Christina M Jackson
• Christopher Shaun Jackson
• Dana Nicole Jackson
• Joseph Myron Jacobus, CRM
• Nick Paul Jacoby, LCSW
• James Resk, M.D., P.C.
• Kevin J Jamison, MD
• Spencer Jamison
• James R Janoski, QMHP

• Pediatric Nurse Practitioner in Oregon City, OR
• Providers in Oregon City, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; 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.