Healthcare Provider Details

I. General information

NPI: 1376363978
Provider Name (Legal Business Name): KATELYN BEILBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST STE 400
PORTLAND OR
97210-2865
US

IV. Provider business mailing address

2525 NW LOVEJOY ST STE 400
PORTLAND OR
97210-2865
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-1933
  • Fax:
Mailing address:
  • Phone: 503-223-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA222454
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: