Provider Demographics
NPI:1053843912
Name:KEDDIE, KALLI (ND)
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:
Last Name:KEDDIE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MELODY CT
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-4018
Mailing Address - Country:US
Mailing Address - Phone:262-501-3410
Mailing Address - Fax:
Practice Address - Street 1:829 NE HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2712
Practice Address - Country:US
Practice Address - Phone:503-883-0333
Practice Address - Fax:503-857-0622
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath