Provider Demographics
NPI:1679681035
Name:NORMAN, KATHI (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11870 SW CLIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5832
Mailing Address - Country:US
Mailing Address - Phone:850-381-3277
Mailing Address - Fax:
Practice Address - Street 1:11870 SW CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5832
Practice Address - Country:US
Practice Address - Phone:850-381-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156252363A00000X
FLPA9103873363A00000X
TNPA0000000970363A00000X
NC133447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP31501Medicare UPIN