Provider Demographics
NPI:1154118925
Name:WINTERS, KACI
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:WINTERS
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 1:2191 RIDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1956
Mailing Address - Country:US
Mailing Address - Phone:503-919-1607
Mailing Address - Fax:
Practice Address - Street 1:6800 SW 105TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5488
Practice Address - Country:US
Practice Address - Phone:971-200-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program