Provider Demographics
NPI:1124427950
Name:KIDBY, MELISSA JEAN (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:KIDBY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0159
Mailing Address - Country:US
Mailing Address - Phone:971-368-1980
Mailing Address - Fax:541-550-2908
Practice Address - Street 1:12999 S MACDONALDS PL
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7529
Practice Address - Country:US
Practice Address - Phone:541-295-5172
Practice Address - Fax:971-362-4818
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404684RN163W00000X
101YM0800X
OR201800978NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1124427950Medicaid