Healthcare Provider Details

I. General information

NPI: 1861538274
Provider Name (Legal Business Name): TRACEY S KATHER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97825 SHOPPING CENTER AVE.
BROOKINGS OR
97415
US

IV. Provider business mailing address

PO BOX 2742
HARBOR OR
97415-0326
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-9800
  • Fax: 541-412-9600
Mailing address:
  • Phone: 541-412-9800
  • Fax: 541-412-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200250089
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: