Individual
AMBER MOULTON-MISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2448 SE 89TH AVE, SUITE 1, PORTLAND, OR 97216-2052
(503) 788-6483
(503) 772-7914
Mailing address
2448 SE 89TH AVE, SUITE 1, PORTLAND, OR 97216-2052
(503) 788-6483
(503) 772-7914
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004679
GA
363A00000X
Physician Assistant
Primary
159703
OR
363A00000X
Physician Assistant
2010-0006
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499847420A
—
GA
05
—
500652768
—
OR
01
—
97WCHDK
MEDICARE-TYPE UNSPECIFIED
GA
Enumeration date
06/07/2006
Last updated
05/21/2015
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