Provider Demographics
NPI:1154685485
Name:WRIGHT, KATIE ELIZABETH (RN, MSN, CNM, APRN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RN, MSN, CNM, APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:WRIGHT
Other - Last Name:BOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CNM
Mailing Address - Street 1:2800 N VANCOUVER AVENUE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-413-4500
Mailing Address - Fax:
Practice Address - Street 1:2800 N VANCOUVER AVENUE
Practice Address - Street 2:SUITE 255
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-413-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001486367A00000X
WAAP60392296367A00000X
OR201503996NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154685485Medicaid