Provider Demographics
NPI:1598122426
Name:LEATHERMAN, KATHERINE PATRICIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PATRICIA
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:PATRICIA
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:3970 DILLARD RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4563
Mailing Address - Country:US
Mailing Address - Phone:541-543-4127
Mailing Address - Fax:
Practice Address - Street 1:4780 VILLAGE PLAZA LOOP STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6624
Practice Address - Country:US
Practice Address - Phone:541-306-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202207822NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health