Provider Demographics
NPI:1679895783
Name:KIRONDE, KRISTY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:KIRONDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:SHORTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28047 SANTIAM HWY
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-9722
Mailing Address - Country:US
Mailing Address - Phone:541-367-5090
Mailing Address - Fax:
Practice Address - Street 1:1815 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-8502
Practice Address - Country:US
Practice Address - Phone:541-754-1369
Practice Address - Fax:844-423-9573
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950090NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily