Provider Demographics
NPI:1295130466
Name:CAMPOS, KATHLEEN (APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHLEEN MAE
Other - Middle Name:RAMIREZ
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:503-494-4779
Mailing Address - Fax:
Practice Address - Street 1:501 SE 172ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-9542
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001797363LF0000X
OR201609585NP-PP363LF0000X
WAAP61451991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily