Provider Demographics
NPI:1407936602
Name:ORTMAN, KAY ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:ELIZABETH
Last Name:ORTMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:ELIZABETH
Other - Last Name:ORTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1601 E 4TH PLAIN
Mailing Address - Street 2:BLDG D7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3753
Mailing Address - Country:US
Mailing Address - Phone:360-696-4061
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:BLDG D7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:360-759-1663
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000034449N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP17173Medicare UPIN
WAVADOOOMedicare ID - Type UnspecifiedVETERANS ADMIN
OR107990Medicare ID - Type Unspecified