CARLY JANE KING NPI 1629635008

NPI Information

  • NPI: 1629635008
  • Provider Name: CARLY JANE KING
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3303 S BOND AVE
    PORTLAND, OR
    ZIP 97239
  • Phone: (503) 494-6594

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NPI Details

Carly Jane King is a medical physician assistant in Portland, OR with 13 years of experience. Carly Jane King NPI is 1629635008. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: STANFORD UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2012

The provider's business location address is:

3303 S BOND AVE
PORTLAND, OR
ZIP 97239-501
Phone: (503) 494-6594
Fax: (503) 494-5385

The NPI 1629635008 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/21/2019 and was last updated on 3/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical58259CALIFORNIANo
2363AM0700XPhysician AssistantMedicalPA207931OREGONYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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