Healthcare Provider Details

I. General information

NPI: 1497186530
Provider Name (Legal Business Name): KATHRYN SPRING MEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date: 12/15/2021
Reactivation Date: 01/05/2022

III. Provider practice location address

3170 STATE ST
MEDFORD OR
97504-8450
US

IV. Provider business mailing address

1050 SW 6TH AVE STE 1100
PORTLAND OR
97204-1153
US

V. Phone/Fax

Practice location:
  • Phone: 207-608-3311
  • Fax:
Mailing address:
  • Phone: 207-608-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2286310
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number202114267NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: