Healthcare Provider Details

I. General information

NPI: 1548189210
Provider Name (Legal Business Name): KRISTEN RANAE GERHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CINDY WAY
SHADY COVE OR
97539-0121
US

IV. Provider business mailing address

165 CINDY WAY
SHADY COVE OR
97539-0121
US

V. Phone/Fax

Practice location:
  • Phone: 541-363-2992
  • Fax:
Mailing address:
  • Phone: 541-363-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number115224
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: