Healthcare Provider Details

I. General information

NPI: 1003292368
Provider Name (Legal Business Name): KATHERINE NALL BIRRER PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2015
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E CENTRAL AVE STE 245
SPOKANE WA
99208-6289
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-824-1686
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60739072
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: