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NPI Code Detail

MEDICARE: KATHERINE FORD

MEDICARE: KATHERINE FORD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA174189OR

General Provider Information

NPI Number : 1609245786
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE FORD
Provider Business Mailing Address
First Line : 541 NE 20TH AVE STE 225
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2895
Country : US
Telephone Number : 503-963-2801
Fax Number : 503-963-2825
Provider Business Practice Location Address
First Line : 1508 DIVISION ST STE 15
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1583
Country : US
Telephone Number : 503-692-3750
Fax Number : 503-691-2324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2015
Last Update Date : 03/04/2024

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Directions to “ KATHERINE FORD ” Practice Location

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