Provider Demographics
NPI:1730197294
Name:LOCH, KRISTIN KATHLEEN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KATHLEEN
Last Name:LOCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:KATHLEEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST
Mailing Address - Street 2:SUITE 256
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2991
Mailing Address - Country:US
Mailing Address - Phone:503-239-7767
Mailing Address - Fax:503-215-6897
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 256
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-239-7767
Practice Address - Fax:503-215-6897
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250138NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232803Medicaid
WA1056568Medicaid
ORR157604Medicare PIN
ORQ16169Medicare UPIN