Provider Demographics
NPI:1427470509
Name:MEJIA, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:HERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 NW AMBERGLEN PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6980
Mailing Address - Country:US
Mailing Address - Phone:971-327-4356
Mailing Address - Fax:971-228-2177
Practice Address - Street 1:1920 NW AMBERGLEN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6980
Practice Address - Country:US
Practice Address - Phone:971-327-4356
Practice Address - Fax:971-228-2177
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247200000XOtherTAXONOMY/#24 TECHNICIAN