Provider Demographics
NPI:1376335257
Name:SORRELS, KATLYN PEARL (PA-C)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:PEARL
Last Name:SORRELS
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 1:5953 DAVIS CREEK RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9719
Mailing Address - Country:US
Mailing Address - Phone:541-500-7052
Mailing Address - Fax:
Practice Address - Street 1:255 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5155
Practice Address - Country:US
Practice Address - Phone:503-576-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA224533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant