Provider Demographics
NPI:1457115818
Name:STONE, CARRIE BROOKE (AGACNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BROOKE
Last Name:STONE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19500 HIDDEN SPRINGS RD APT 22
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2342
Mailing Address - Country:US
Mailing Address - Phone:760-271-4711
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2000
Practice Address - Country:US
Practice Address - Phone:503-413-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61526388363LA2100X, 363LA2200X
OR10021883363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care