KAYLA JERDE (NPI# 1497226716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497226716 |
| Entity Type | Individual |
| Full Name | KAYLA JERDE |
| Credential | PA-C |
| Practice Address |
24076 Se Stark St Ste 230 Gresham OR 97030-3385 |
| Mailing Address |
847 Ne 19th Ave Ste 300 Portland OR 97232-2686 |
| Practice Telephone | 5034882600 |
| Practice Fax Number | 5034655468 |
| Mailing Telephone | 5039632801 |
| Mailing Fax Number | 5039632825 |
| Enumeration Date | 2018-12-14 |
| Last Update Date | 2019-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA191582 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500758641 | 05 | |
| WA | 2115765 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1111 Ne 99th Ave Ste 101, Portland, OR 972209442 | 5034882626 | 5034882630 |
| Street Address |
24076 SE STARK ST STE 230 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3385 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811164262 | Carrie Maiorana Brown | Otolaryngology | 24076 Se Stark St Ste 230, Gresham, OR 97030 | 2008-05-14 |
| 1639515448 | Nicole Lynn Frazier | Audiologist-Hearing Aid Fitter | 24076 Se Stark St Ste 230, Gresham, OR 97030-3385 | 2013-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003898149 | Kimberly Pohlman | Physician Assistant | 2850 Se Powell Valley Rd, Gresham, OR 97080-1494 | 2005-11-15 |
| 1952858300 | Loan Duong | Physician Assistant | 24988 Se Stark St, Gresham, OR 97030-8322 | 2016-09-01 |
| 1265897599 | David E Strickland | Physician Assistant | 24900 Se Stark St Ste 109, Gresham, OR 97030-3381 | 2015-12-31 |
| 1598190274 | Kendra M Underhill | Physician Assistant | 2850 Se Powell Valley Rd Ste 100, Gresham, OR 97080 | 2013-09-12 |
| 1114279965 | Marissa Dorau | Physician Assistant | 2150 Ne Division St Ste 103, Gresham, OR 97030-5858 | 2012-10-03 |
| 1972567725 | Kristofer R Mcallister | Physician Assistant | 831 Nw Council Dr Ste 145, Gresham, OR 97030-3795 | 2006-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808605 | Pilar Lorena Lopez | Physician Assistant | 7675 Sw Spruce St, Tigard, OR 97223-8723 | 2020-10-15 |
| 1730787615 | Michael Hisao Mun Ho Pang | Physician Assistant | 1245 Sw 160th Ave, Beaverton, OR 97006-5052 | 2020-10-13 |
| 1144834805 | Logan Michael Johnston | Physician Assistant | 3319 Edgeview Ln, Forest Grove, OR 97116-1094 | 2020-09-01 |
| 1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
| 1033751433 | Trisha K Loch | Physician Assistant | 781 W Central, Sutherlin, OR 97479 | 2019-10-17 |
| 1154805729 | Ronald William Strohmeyer | Physician Assistant | 2327 S.w. 4th Ave, Ontario, OR 97914 | 2018-09-19 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1659828044 | Ryan Jones | Physician Assistant | 1775 Thompson Rd Bay Or97420, Coos Bay, OR 97420-2125 | 2016-09-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.