Basic Information
| Provider Information | |||||||||
| NPI: | 1174602247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCPHERSON | ||||||||
| FirstName: | KATRINA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2265 EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033254321 | ||||||||
| FaxNumber: | 5033254905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | FOREST GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971161939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033572136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 04/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME89509 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 261Q00000X | MD29316 | OR | N | Ambulatory Health Care Facilities | Clinic/Center | 208000000X | MD29316 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 269803000 | 05 | FL | MEDICAID | 1134146939 | 05 | OR | MEDICAID |