Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kellie L Graybosch, PA-C

Individual provider Physician Assistant · NPI 1720362882

Kellie L Graybosch, PA-C is a Physician Assistant in Portland, Oregon. Qualified in 2011, 15 years ago. Practices with Providence Health and Services Oregon, a 1,426-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
15
Licensed in
OR
In the registry since
2011
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9427 SW Barnes Rd Ste 495
Portland, OR 97225-6652
Phone: (503) 216-1661
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA156616 (OR)

Record details

NPI number1720362882
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 6, 2011
Last updated in NPPESMarch 10, 2021
Certification dateMarch 10, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Providence Health And Services Oregon — 1426 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

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