Provider Demographics
NPI:1629305040
Name:SISSON, KATHRYN I (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:I
Last Name:SISSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:I
Other - Last Name:HOMEDEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1975 MCPHERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-756-2020
Mailing Address - Fax:541-756-8982
Practice Address - Street 1:1975 MCPHERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3482
Practice Address - Country:US
Practice Address - Phone:541-756-2020
Practice Address - Fax:541-756-8982
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081046758RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse