Provider Demographics
NPI:1558596924
Name:MAYHEW, KATHRYN (PAC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:230 ROWE ST
Mailing Address - City:WHEELER
Mailing Address - State:OR
Mailing Address - Zip Code:97147-0176
Mailing Address - Country:US
Mailing Address - Phone:503-368-5182
Mailing Address - Fax:503-368-5590
Practice Address - Street 1:230 ROWE ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:OR
Practice Address - Zip Code:97147
Practice Address - Country:US
Practice Address - Phone:503-368-5182
Practice Address - Fax:503-368-5590
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA150437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant