Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201460166NP-PP | OR |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP60113467 | WA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 200950091 | OR |
NPI | 1023248846 |
---|---|
Provider Name | Ms. Kristine Marie Simpson |
First Address | Portland, OR 97208-4399 |
Second Address | Portland, OR 97232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 19/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9664137 | (05) | WA |