KENNETH LEE RECKARD PA-C NPI 1083635916

NPI Information

NPI: 1083635916
Provider Name: KENNETH LEE RECKARD, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
19250 SW 90TH AVE
TUALATIN, OR
ZIP 97062
Phone: (503) 692-3750
Get Directions

Kenneth Lee Reckard, PA-C is a medical physician assistant in Tualatin, OR with 19 years of experience. Kenneth Lee Reckard, PA-C NPI is 1083635916. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

19250 SW 90TH AVE
TUALATIN, OR
ZIP 97062-585
Phone: (503) 692-3750
Fax: (503) 691-2324

The NPI 1083635916 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 7/23/2006 and was last updated on 12/1/2021.

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	363AM0700X	Physician Assistant	Medical	PA01082	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1083635916	MEDICAID	WASHINGTON
2	500604351	MEDICAID	OREGON

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: 5/5/2024

NPI Synchronization or Removal

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