Individual
KRISTIN H BOURRET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4400 NE HALSEY ST STE 102, PORTLAND, OR 97213-1545
(503) 962-1000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01095
OR
363AS0400X
Surgical Physician Assistant
PA01095
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286755
—
OR
Enumeration date
06/12/2006
Last updated
04/19/2024
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