Provider Demographics
NPI:1083039457
Name:WHITE, KRISTINE SUSAN (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:SUSAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 WESTLAKE DR STE 25
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7700
Mailing Address - Country:US
Mailing Address - Phone:503-854-7160
Mailing Address - Fax:503-886-8961
Practice Address - Street 1:14523 WESTLAKE DR STE 25
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7700
Practice Address - Country:US
Practice Address - Phone:503-854-7160
Practice Address - Fax:503-886-8961
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201508490RN-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010783400Medicaid
FL010783400Medicaid