Provider Demographics
NPI:1457876633
Name:MITCHELL, KRISTIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 NINA LN
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8715
Mailing Address - Country:US
Mailing Address - Phone:503-789-7021
Mailing Address - Fax:
Practice Address - Street 1:1675 SW MARLOW AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5102
Practice Address - Country:US
Practice Address - Phone:503-430-1777
Practice Address - Fax:503-372-5119
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201706323NP-PP207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine