Provider Demographics
NPI:1851831119
Name:MURPHY, KRISTEN SARA (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SARA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 SW VILLAGE GLENN CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6038
Mailing Address - Country:US
Mailing Address - Phone:310-804-9408
Mailing Address - Fax:
Practice Address - Street 1:13430 SW VILLAGE GLENN CT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6038
Practice Address - Country:US
Practice Address - Phone:310-804-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC174769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist