MEDICARE: KRISTA ELIZABETH MILLER

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	363L00000X	Nurse Practitioner	AP.70077186-NP	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP.70077186-NP	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10054272	OR
4	363L00000X	Nurse Practitioner	10054272	OR

General Provider Information

NPI Number	:	1447118831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA ELIZABETH MILLER

Provider Business Mailing Address
First Line	:	1109 NE PRESCOTT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-4659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 NE PRESCOTT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-4659
Country	:	US
Telephone Number	:	208-596-8107
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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