Individual
KRISTINE JOST WINDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
9155 SW BARNES RD, SUITE 440, PORTLAND, OR 97225-6625
(503) 297-3766
(503) 297-8148
Mailing address
975 SE SANDY BLVD, SUITE 201, PORTLAND, OR 97214-1308
(503) 236-0775
(503) 236-0786
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00978
OR
363AS0400X
Surgical Physician Assistant
PA10004840
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500602008
—
OR
Enumeration date
08/19/2005
Last updated
09/13/2012
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