Provider Demographics
NPI:1386701936
Name:GARRISON, KIMBERLEY ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 SW BECKER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7252
Mailing Address - Country:US
Mailing Address - Phone:503-246-0116
Mailing Address - Fax:503-246-0116
Practice Address - Street 1:32100 SW FRENCH PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6400
Practice Address - Country:US
Practice Address - Phone:503-694-2800
Practice Address - Fax:503-694-5124
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health