Individual ProviderKimberly PeoroPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011(034) 944-3145(503) 494-4314PECOS EnrollmentBased on the most recent information from CMS, provider Kimberly Peoro is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1629555115Provider TypeIndividualFull NamePeoro, KimberlyCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date7/26/2018Last Updated7/12/2022Contact InformationPractice LocationPractice Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(034) 944-3145Fax(503) 346-6810Mailing LocationMailing Address3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011Phone(503) 494-4314Fax(503) 346-6810Provider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA195602Oregon