Provider Demographics
NPI:1437042777
Name:MCDONALD, AMY KELLEY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KELLEY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 NE AINSWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9017
Mailing Address - Country:US
Mailing Address - Phone:503-257-1732
Mailing Address - Fax:
Practice Address - Street 1:1001 SE 135TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1924
Practice Address - Country:US
Practice Address - Phone:503-261-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202209989RN163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool