KELLY WULF PA-C NPI 1750654323

NPI Information

NPI: 1750654323
Provider Name: KELLY WULF, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: CLACKAMAS DERMATOLOGY PC

PECOS Registration: Yes

Address:
2565 NW LOVEJOY ST
SUITE 100
PORTLAND, OR
ZIP 97210
Phone: (503) 279-9700
Get Directions

Kelly Wulf, PA-C is a medical physician assistant in Portland, OR with 11 years of experience. Kelly Wulf, PA-C NPI is 1750654323. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2565 NW LOVEJOY ST
SUITE 100
PORTLAND, OR
ZIP 97210-996
Phone: (503) 279-9700
Fax: (503) 279-8114

The NPI 1750654323 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 2/13/2012 and was last updated on 11/8/2018.

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
1	207N00000X	Dermatology		PA164512	OREGON	No
2	363A00000X	Physician Assistant		PA164512	OREGON	No
3	363AM0700X	Physician Assistant	Medical	PA164512	OREGON	Yes

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: 11/14/2023

NPI Synchronization or Removal

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