Provider Demographics
NPI:1679566111
Name:EVERETT, KRISTIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:EVERETT
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 1:2525 12TH ST SE STE 260
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2282
Mailing Address - Country:US
Mailing Address - Phone:971-239-0001
Mailing Address - Fax:
Practice Address - Street 1:2525 12TH ST SE STE 260
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2282
Practice Address - Country:US
Practice Address - Phone:033-914-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47999207Q00000X
ORMD212644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47999OtherSTATE LICENSE
ORMD212644OtherSTATE LICENSE
ORMD212644OtherSTATE LICENSE