Kristen Elise Nicolescu, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA159795 Issued in OR

Practice address

551 Lone Pine Blvd Ste 302
The Dalles, OR 97058-9404

Phone

(541) 506-6500

Fax

(541) 506-6501

NPI assigned

Oct 30, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment NPD
• Peacehealth

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Medicare reassignment NPD
• One Community Health

  • Federally Qualified Health Center (FQHC)
  • Hood River, OR
  • NPI 1851385918
  Medicare reassignment NPD (past)
• Emergency Medicine Associates PC

  • Emergency Medicine Physician
  • Vancouver, WA
  • NPI 1962453860
  Medicare reassignment
• One Community Health

  • Community/Retail Pharmacy
  • The Dalles, OR
  • NPI 1104666064
  NPD
• Peacehealth

  • Cardiovascular Disease Physician
  • Vancouver, WA
  • NPI 1003194911
  NPD
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1154351336

  Physician Assistant

  NPD (past)
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1407887052
  NPD (past)

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

{
    "created_epoch": "1319932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1457637860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1520",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970588003",
            "telephone_number": "541-298-7971",
            "fax_number": "541-296-6431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 LONE PINE BLVD STE 302",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970589404",
            "telephone_number": "541-506-6500",
            "fax_number": "541-506-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLESCU",
        "first_name": "KRISTEN",
        "middle_name": "ELISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-30",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4277",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA159795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500654260",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Nevara, ARNP
• Camdon M Newcomer
• John Worth Newman, RPH
• Holly Nichols, DMD
• Lacey A Nichols, LCSW
• Jadin T Nipko
• Nisha Jackson PC
• Jammie Niz
• Norco, Inc.
• Hopeanne Norris, LMT

• Physician Assistant in The Dalles, OR
• Providers in The Dalles, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.