Basic Information
| Provider Information | |||||||||
| NPI: | 1588968085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSKIE | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7650 SW BEVELAND RD | ||||||||
| Address2: | SUITE200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038551620 | ||||||||
| FaxNumber: | 5038403299 | ||||||||
| Practice Location | |||||||||
| Address1: | 7431 NW EVERGREEN PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037343700 | ||||||||
| FaxNumber: | 5034738462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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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 | 367A00000X | 201350115NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 500683681 | 05 | OR | MEDICAID | R172744 | 01 | OR | MEDICARE PTAN | OTHER |