Kimberly Anne Nistad, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

00345 Issued in OR

Practice address

1331 SE Birch St
Portland, OR 97214-5335

Phone

(503) 309-7267

NPI assigned

May 4, 2007

Last updated

Oct 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Anne Booth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1144432626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 SE BIRCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145335",
            "telephone_number": "503-309-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 SE BIRCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145335",
            "telephone_number": "503-309-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISTAD",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2015-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "00345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "BOOTH",
            "middle_name": "ANNE",
            "credential": "KIMBERLY BOOTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Fumiyo Nishimoto, LCSW
• Nanette Helene Niski, L.AC.
• Jennifer Elizabeth Nisley
• Jennifer Elizabeth Nisly
• Haley Marie Nisson, BS
• Matthew David Niswander
• Kenneth Masahiro Nitta, M.D.
• Debora Nitu, RN
• Danielle Briana-Hansen Nix, LMT
• Sarah G Nixon Meyer, LCSW

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.