Provider Demographics
NPI:1063069987
Name:HARRIS, KELSEY OLESON (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:OLESON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:SHEREE
Other - Last Name:OLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 W TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6481
Mailing Address - Country:US
Mailing Address - Phone:503-821-9230
Mailing Address - Fax:
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 111
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7357
Practice Address - Country:US
Practice Address - Phone:503-531-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant