Healthcare Provider Details

I. General information

NPI: 1386101913
Provider Name (Legal Business Name): KRISTA RAE ALLEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date: 04/13/2020
Reactivation Date: 04/17/2020

III. Provider practice location address

1460 G ST
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

PO BOX 920138
DALLAS TX
75392-0138
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58.031541
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A21115
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO219699
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: