Provider Demographics
NPI:1659923779
Name:LATTIMER, KATHERINE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LATTIMER
Suffix:
Gender:U
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LATTIMER-RYNEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2216 NE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4622
Mailing Address - Country:US
Mailing Address - Phone:503-701-4880
Mailing Address - Fax:
Practice Address - Street 1:4212 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1422
Practice Address - Country:US
Practice Address - Phone:503-249-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403853RN163W00000X, 163WE0003X, 163WP0808X
OR10005847363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10005847OtherOREGON STATE BOARD OF NURSING
OR201403853RNOtherOREGON STATE BOARD OF NURSING