Provider Demographics
NPI:1992050249
Name:REIS, KATHERINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:REIS
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12042 SE SUNNYSIDE RD # 511
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8382
Mailing Address - Country:US
Mailing Address - Phone:503-683-3627
Mailing Address - Fax:402-695-4629
Practice Address - Street 1:12525 SE CREST WAY
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-683-3627
Practice Address - Fax:402-695-4629
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201700405NP-PP2084P0800X
VTTBD363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty