Organization
ILLUMINA INTEGRATIVE PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA ELIZABETH MILLER APRN, PMHNP-BC (OWNER)
(208) 596-8107
Entity
Organization
Contact information
Practice address
1109 NE PRESCOTT ST, PORTLAND, OR 97211-4659
(208) 696-8107
Mailing address
1109 NE PRESCOTT ST, PORTLAND, OR 97211-4659
(208) 696-8107
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
171400000X
Health & Wellness Coach
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/14/2026
Last updated
01/14/2026
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