Provider Demographics
NPI:1881345817
Name:PLACE, KRISTEN SIERRA (PA-C MSPAS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SIERRA
Last Name:PLACE
Suffix:
Gender:F
Credentials:PA-C MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8672
Mailing Address - Country:US
Mailing Address - Phone:503-305-6262
Mailing Address - Fax:
Practice Address - Street 1:11675 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8672
Practice Address - Country:US
Practice Address - Phone:503-305-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2507363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant