Basic Information
| Provider Information | |||||||||
| NPI: | 1699718163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | KATI | ||||||||
| MiddleName: | GRAHAM | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 NW NAITO PKWY STE 185 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972092535 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6120-B WOODLAND AVENUE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157274721 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP009024 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | 201909193NP-PP | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.