1013840891 NPI number — DR. KRISTINA MELODY LASSFOLK BETTENCOURT PHARMD

Table of content: DR. KRISTINA MELODY LASSFOLK BETTENCOURT PHARMD (NPI 1013840891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013840891 NPI number — DR. KRISTINA MELODY LASSFOLK BETTENCOURT PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETTENCOURT
Provider First Name:
KRISTINA
Provider Middle Name:
MELODY LASSFOLK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LASSFOLK
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
MELODY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013840891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 GRANTS PASS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97526-2359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-474-7234
Provider Business Mailing Address Fax Number:
541-474-7240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 GRANTS PASS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-474-7234
Provider Business Practice Location Address Fax Number:
541-474-7240
Provider Enumeration Date:
06/03/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0014938 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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