Provider Demographics
NPI:1619517406
Name:ACORD, KRISTINA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:ACORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:LEIDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18738 SE GRANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5518
Mailing Address - Country:US
Mailing Address - Phone:541-499-8887
Mailing Address - Fax:
Practice Address - Street 1:124 NE 181ST AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6565
Practice Address - Country:US
Practice Address - Phone:503-489-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201911095NP-PP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine