Provider Demographics
NPI:1619015369
Name:TRICARICO, KRISTA LYNN (ND)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:LYNN
Last Name:TRICARICO
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 1:1743 NE JUNIOR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4859
Mailing Address - Country:US
Mailing Address - Phone:503-593-8900
Mailing Address - Fax:503-234-2805
Practice Address - Street 1:1016 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2513
Practice Address - Country:US
Practice Address - Phone:503-593-8900
Practice Address - Fax:503-234-2805
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1493175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath