Provider Demographics
NPI:1497186530
Name:MEAD, KATHRYN SPRING
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SPRING
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7222
Mailing Address - Country:US
Mailing Address - Phone:207-608-3311
Mailing Address - Fax:
Practice Address - Street 1:125 S CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7222
Practice Address - Country:US
Practice Address - Phone:207-608-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2022-01-20
Deactivation Date:2021-12-15
Deactivation Code:
Reactivation Date:2022-01-05
Provider Licenses
StateLicense IDTaxonomies
MARN2286310163W00000X
OR202114267NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse