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NPI Code Detail

MEDICARE: MISTY MINER CMA

MEDICARE: MISTY MINER CMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantOR

General Provider Information

NPI Number : 1831056308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY MINER CMA
Provider Business Mailing Address
First Line : 2210 N ELDORADO AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-6418
Country : US
Telephone Number : 541-883-1030
Fax Number : 541-884-2338
Provider Business Practice Location Address
First Line : 2210 N ELDORADO AVE
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-6418
Country : US
Telephone Number : 541-883-1030
Fax Number : 541-884-2338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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Directions to “ MISTY MINER CMA” Practice Location

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