Provider Demographics
NPI:1689051690
Name:REED, MARY KATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:REED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:VOLCKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3521 NW SAMARITAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4744
Mailing Address - Country:US
Mailing Address - Phone:541-768-6119
Mailing Address - Fax:
Practice Address - Street 1:3521 NW SAMARITAN DR STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4744
Practice Address - Country:US
Practice Address - Phone:541-768-6119
Practice Address - Fax:541-768-6120
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical