Provider Demographics
NPI:1942574488
Name:ORTA, KIMBERLY ANN (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:ORTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:MCCLOUD
Mailing Address - State:CA
Mailing Address - Zip Code:96057-0601
Mailing Address - Country:US
Mailing Address - Phone:530-964-2389
Mailing Address - Fax:530-964-3141
Practice Address - Street 1:824 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2137
Practice Address - Country:US
Practice Address - Phone:530-926-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604263163W00000X
OR201705838NP-PP363LF0000X
CA95007009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1083656367OtherCURRY MEDICAL CENTER'S NPI
OR1487696985OtherCURRY GENERAL HOSPITAL'S NPI
OR500730808Medicaid
CA1942574488Medicaid