Provider Demographics
NPI:1467019091
Name:HALE, KATHRYN RICHELLE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RICHELLE
Last Name:HALE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RICHELLE
Other - Last Name:COLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:422 SE 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1339
Mailing Address - Country:US
Mailing Address - Phone:580-465-5755
Mailing Address - Fax:
Practice Address - Street 1:2050 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9764
Practice Address - Country:US
Practice Address - Phone:503-981-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201810080NP-PP363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care