MEDICARE: MS. KATHERINE ROSE MCELHANEY PA-C, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	20031	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61016303	OTHER	WA	PA-C LICENSE
2	194182	OTHER	OR	PA-C LICENSE
3	20031	OTHER	CA	PA-C LICENSE

General Provider Information

NPI Number	:	1134398407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE ROSE MCELHANEY PA-C, MS

Provider Business Mailing Address
First Line	:	1455 NW IRVING ST STE 600
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2277
Country	:	US
Telephone Number	:	503-684-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 NW IRVING ST STE 600
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2277
Country	:	US
Telephone Number	:	503-684-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	08/20/2020

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