Healthcare Provider Details

I. General information

NPI: 1528686631
Provider Name (Legal Business Name): KATELYN MICHELLE GRAFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BISON RD
CHESTER MT
59522-7719
US

IV. Provider business mailing address

222 SE 8TH AVE STE 536
HILLSBORO OR
97123-4218
US

V. Phone/Fax

Practice location:
  • Phone: 406-945-8055
  • Fax:
Mailing address:
  • Phone: 503-352-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61360188
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: