Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201807434NP-PP | OR |
NPI | 1023531126 |
---|---|
Provider Name | Mrs. Kirsten Emily Teixeira |
First Address | Dallas, OR 97338-1996 |
Second Address | Dallas, OR 97338-1996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2017 |
Last Update Date | 20/09/2019 |