Provider Demographics
NPI:1023531126
Name:TEIXEIRA, KIRSTEN EMILY (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:EMILY
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:EMILY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:182 SW ACADEMY ST STE 333
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1996
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST STE 333
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201807434NP-PP363LP0808X
OR201403790RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse