Provider Demographics
NPI:1164772893
Name:SHAFFER, KRISTEN G (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:G
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 SE KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8342
Mailing Address - Country:US
Mailing Address - Phone:415-516-6143
Mailing Address - Fax:877-767-3163
Practice Address - Street 1:4550 KRUSE WAY STE 125
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3533
Practice Address - Country:US
Practice Address - Phone:503-457-7100
Practice Address - Fax:877-767-3163
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0097262363LF0000X
OR201402108NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily