Provider Demographics
NPI:1003872425
Name:WOODS, KRISTIN D (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:WOODS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-8000
Mailing Address - Fax:806-288-7920
Practice Address - Street 1:1806 QUINCY ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072
Practice Address - Country:US
Practice Address - Phone:806-288-7891
Practice Address - Fax:806-288-7920
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04607363A00000X
ORPA188159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500745750Medicaid
Q59757Medicare UPIN