MEDICARE: KATIE ELIZABETH METZGER PA

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

General Provider Information

NPI Number	:	1932554680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ELIZABETH METZGER PA

Provider Business Mailing Address
First Line	:	1375 N 10TH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-2099
Country	:	US
Telephone Number	:	503-769-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 N 10TH AVE
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-2099
Country	:	US
Telephone Number	:	503-494-9645
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	07/21/2022

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