Healthcare Provider Details

I. General information

NPI: 1881322360
Provider Name (Legal Business Name): MICHAELA MARIE CARLSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 100
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

1140 OREGON ASH CIR
KLAMATH FALLS OR
97601-8708
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6733
  • Fax: 541-274-2006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202211974NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: