Healthcare Provider Details

I. General information

NPI: 1619389194
Provider Name (Legal Business Name): MEGAN KATHERINE BARTLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SE MONROE ST
MILWAUKIE OR
97222-6636
US

IV. Provider business mailing address

1233 EDGEWATER ST NW
SALEM OR
97304-4049
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax: 503-659-4730
Mailing address:
  • Phone: 503-378-7526
  • Fax: 503-585-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number168478
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: