Basic Information
| Provider Information | |||||||||
| NPI: | 1003986696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAPER | ||||||||
| FirstName: | CATHRYN | ||||||||
| MiddleName: | DIANN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 MEDICAL CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419307260 | ||||||||
| FaxNumber: | 5419307220 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SW RAMSEY AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419307223 | ||||||||
| FaxNumber: | 5419307221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP3708 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 201907305NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 9647686 | 05 | WA | MEDICAID |