Healthcare Provider Details

I. General information

NPI: 1437044781
Provider Name (Legal Business Name): KAITLYNN RUTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE RUTH

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N LOMBARD ST
PORTLAND OR
97203-3006
US

IV. Provider business mailing address

9000 N LOMBARD ST
PORTLAND OR
97203-3006
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5558
  • Fax:
Mailing address:
  • Phone: 503-988-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number232723
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: