Healthcare Provider Details

I. General information

NPI: 1871800615
Provider Name (Legal Business Name): KATHARINE THERESA MITCHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 SW BARNES RD
PORTLAND OR
97225-6625
US

IV. Provider business mailing address

9155 SW BARNES RD
PORTLAND OR
97225-6625
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-6334
  • Fax: 360-297-2360
Mailing address:
  • Phone: 503-297-6334
  • Fax: 360-297-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60268388
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250033
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: