Provider Demographics
NPI:1699928168
Name:SIX, KRISTY R (DPM)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:R
Last Name:SIX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW BLUFF DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1697
Mailing Address - Country:US
Mailing Address - Phone:541-728-0858
Mailing Address - Fax:541-728-0704
Practice Address - Street 1:400 SW BLUFF DR STE 220
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1697
Practice Address - Country:US
Practice Address - Phone:541-728-0858
Practice Address - Fax:541-728-0704
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP125967213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500616912Medicaid