Provider Demographics
NPI:1386949295
Name:CLIFFORD, KIMBERLY M (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 SE STARK ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2313
Mailing Address - Country:US
Mailing Address - Phone:303-668-6784
Mailing Address - Fax:458-256-4018
Practice Address - Street 1:7831 SE STARK ST STE 211
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2313
Practice Address - Country:US
Practice Address - Phone:303-668-6784
Practice Address - Fax:458-256-4018
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60762691363A00000X
ORPA184402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant