Individual
CRYSTAL CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213373
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA213373
OREGON PA LICENSE
OR
Enumeration date
06/04/2021
Last updated
11/16/2022
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