MEDICARE: KRISTI LYNN LUCAS

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
1	172V00000X	Community Health Worker	115815	OR

General Provider Information

NPI Number	:	1841143286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI LYNN LUCAS

Provider Business Mailing Address
First Line	:	14279 S GLEN OAK ROAD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045
Country	:	US
Telephone Number	:	503-657-7629
Fax Number	:	503-557-8651

Provider Business Practice Location Address
First Line	:	14279 S GLEN OAK ROAD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045
Country	:	US
Telephone Number	:	503-657-7629
Fax Number	:	503-557-8651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ KRISTI LYNN LUCAS ” Practice Location

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