Provider Demographics
NPI:1386017218
Name:CRISP, KARA (ND)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 SE MORRISON ST STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-6309
Mailing Address - Country:US
Mailing Address - Phone:503-882-0752
Mailing Address - Fax:
Practice Address - Street 1:819 SE MORRISON ST STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6309
Practice Address - Country:US
Practice Address - Phone:503-882-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3061175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717940Medicaid