Provider Demographics
NPI:1285884114
Name:KELBAR, HEIDI JO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:KELBAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:831 NW COUNCIL DR STE 145
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3795
Practice Address - Country:US
Practice Address - Phone:503-489-2650
Practice Address - Fax:503-489-2659
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA164192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500726635Medicaid