Healthcare Provider Details

I. General information

NPI: 1174602247
Provider Name (Legal Business Name): KATRINA MCPHERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MAPLE ST
FOREST GROVE OR
97116-1939
US

IV. Provider business mailing address

2265 EXCHANGE ST
ASTORIA OR
97103-3331
US

V. Phone/Fax

Practice location:
  • Phone: 503-357-2136
  • Fax:
Mailing address:
  • Phone: 503-325-4321
  • Fax: 503-325-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD29316
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29316
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME89509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: