Provider Demographics
NPI:1750350336
Name:ARBUCKLE, KATHLEEN M (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:ARBUCKLE
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:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N MONROE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4243
Practice Address - Country:US
Practice Address - Phone:541-686-1427
Practice Address - Fax:541-341-1693
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088000336N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR209366Medicaid
P62815Medicare UPIN
ORR113665Medicare PIN