Provider Demographics
NPI:1366045924
Name:FLOWERS, KIMBERLY (ANP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 SE MAIN ST STE 2011
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2457
Mailing Address - Country:US
Mailing Address - Phone:503-255-3404
Mailing Address - Fax:
Practice Address - Street 1:10101 SE MAIN ST STE 2011
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2457
Practice Address - Country:US
Practice Address - Phone:503-255-3404
Practice Address - Fax:503-255-4750
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168424A363LG0600X
OR10016545363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology