Provider Demographics
NPI:1689304628
Name:THURBER, KRISTAN
Entity type:Individual
Prefix:MRS
First Name:KRISTAN
Middle Name:
Last Name:THURBER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74B CENTENNIAL LOOP STE 300
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7925
Mailing Address - Country:US
Mailing Address - Phone:208-351-2945
Mailing Address - Fax:
Practice Address - Street 1:74B CENTENNIAL LOOP STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7925
Practice Address - Country:US
Practice Address - Phone:541-686-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant