Healthcare Provider Details

I. General information

NPI: 1083141196
Provider Name (Legal Business Name): KRISTA ESPENSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16463 BOONES FERRY RD. SUITE #300
LAKE OSWEGO OR
97035
US

IV. Provider business mailing address

16463 BOONES FERRY RD. SUITE #300
LAKE OSWEGO OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-658-9351
  • Fax: 541-708-5934
Mailing address:
  • Phone: 503-658-9351
  • Fax: 541-708-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-60617080
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200540989-RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201804013NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: