Individual
KRYSTA ST MICHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MEDICAL STUDENT
Contact information
Practice address
2730 SW MOODY AVENUE PORTLAND, OR, PORTLAND, OR 97201
(541) 510-3165
Mailing address
2730 SW MOODY AVENUE PORTLAND, OR, PORTLAND, OR 97201
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PG224993
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/07/2022
Last updated
08/25/2025
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