Provider Demographics
NPI:1801209721
Name:MEEKER, KATHERINE M (FNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:MEEKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E ALDER ST
Mailing Address - Street 2:
Mailing Address - City:ALSEA
Mailing Address - State:OR
Mailing Address - Zip Code:97324-9634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 DRAGON DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OR
Practice Address - Zip Code:97456-9604
Practice Address - Country:US
Practice Address - Phone:541-766-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404304RN163W00000X
OHRN.389819-163W00000X
OR201404305NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619915113OtherFACILITY NPI NUMBER
OR500674475Medicaid