Healthcare Provider Details

I. General information

NPI: 1467305615
Provider Name (Legal Business Name): KATHERYN ANNE FAULCONER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 8TH ST STE 110
VANCOUVER WA
98660-3294
US

IV. Provider business mailing address

101 E 8TH ST STE 110
VANCOUVER WA
98660-3294
US

V. Phone/Fax

Practice location:
  • Phone: 805-816-2763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6481215
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70128898-NP
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039400
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10060959
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: