Provider Demographics
NPI:1578670824
Name:KRIDER, KATHLEEN EVA (MS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:EVA
Last Name:KRIDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 SW BARNES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6603
Mailing Address - Country:US
Mailing Address - Phone:503-216-1881
Mailing Address - Fax:
Practice Address - Street 1:9205 SW BARNES RD
Practice Address - Street 2:WEST PAVILION, SUITE #200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6603
Practice Address - Country:US
Practice Address - Phone:503-216-1234
Practice Address - Fax:503-216-1750
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078041304RN3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health