Provider Demographics
NPI:1225054646
Name:CARR, KIRSTEN MARIE WINN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:MARIE WINN
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 SW IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1617
Mailing Address - Country:US
Mailing Address - Phone:503-740-6693
Mailing Address - Fax:503-379-0944
Practice Address - Street 1:1675 SW MARLOW AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5102
Practice Address - Country:US
Practice Address - Phone:503-430-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33275207Q00000X
HI19947207Q00000X
WAMD606724207Q00000X
ORMD26408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine