Provider Demographics
NPI:1043017221
Name:STUTESMAN, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:STUTESMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82128 MT ZION DR
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-9778
Mailing Address - Country:US
Mailing Address - Phone:541-517-0066
Mailing Address - Fax:
Practice Address - Street 1:72C CENTENNIAL LOOP STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2453
Practice Address - Country:US
Practice Address - Phone:541-972-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113057175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist