Basic Information
| Provider Information | |||||||||
| NPI: | 1255913711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | LEYLAND | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70368 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974750120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148527775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 590 COUNTRY CLUB PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974016038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416862922 | ||||||||
| FaxNumber: | 5416831709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2021 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 202105512NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 500794449 | 05 | OR | MEDICAID |