Provider Demographics
NPI:1972567725
Name:MCALLISTER, KRISTOFER R (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:R
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E 19TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3385
Mailing Address - Country:US
Mailing Address - Phone:541-316-6575
Mailing Address - Fax:541-210-8913
Practice Address - Street 1:831 NW COUNCIL DR STE 145
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3795
Practice Address - Country:US
Practice Address - Phone:503-666-6717
Practice Address - Fax:503-666-6745
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q64264Medicare UPIN
ORQ64264Medicare UPIN