Individual provider Active NPI

Kimberly Ann Orta, NP

  • Family Nurse Practitioner
  • Brookings, OR
National Provider Identifier
1942574488
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95007009 Issued in CA
Practice address
500 5TH St
Brookings, OR 97415-9702
Phone
(541) 412-2000
Fax
(541) 412-2080
NPI assigned
Mar 1, 2012
Last updated
Apr 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201705838NP-PP OR
Family Nurse Practitioner 363LF0000X 95007009 CA Primary
Registered Nurse 163W00000X 604263 CA

Addresses

Primary practice location

500 5TH St
Brookings, OR 97415-9702

Mailing address

500 5TH St
Brookings, OR 97415-9702
Phone (541) 412-2000

Other identifiers 4

IdentifierTypeStateIssuer
1942574488MedicaidCA
1487696985OtherORCURRY GENERAL HOSPITAL'S NPI
1083656367OtherORCURRY MEDICAL CENTER'S NPI
500730808MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170906002665 CA Practitioner - Nurse Practitioner 2567735921 Reassigns benefits to 2 organizations
I20170906003757 OR Practitioner - Nurse Practitioner 2567735921 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
604263CAMDRegistered Nurse
95007009CAMDFamily Nurse Practitioner
201705838NP-PPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
McCloud Healthcare Clinic, Inc. CurrentSince Mar 29, 2024 Accepting new patients
McCloud Healthcare Clinic, Inc. CurrentSince Mar 29, 2024 Accepting new patients
Tahoe Carson Valley Medical Group Inc CurrentSince Jan 1, 2020 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Curry Health District Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

4309 Stagecoach Rd
Dunsmuir, CA 96025
Phone (530) 235-2205

824 Pine St
Mount Shasta, CA 96067
Phone (530) 926-4528

1090 3rd St
South Lake Tahoe, CA 96150
Phone (530) 543-5660

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

2201 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5550

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1942574488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159702",
            "telephone_number": "541-412-2000",
            "fax_number": "714-707-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159702",
            "telephone_number": "541-412-2000",
            "fax_number": "541-412-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTA",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-01",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201705838NP-PP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95007009",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "604263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942574488",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY GENERAL HOSPITAL'S NPI",
            "identifier": "1487696985",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CURRY MEDICAL CENTER'S NPI",
            "identifier": "1083656367",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500730808",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, OR

Sources for this page

Verify at the official NPI Registry.