Provider Demographics
NPI:1467544320
Name:WINANS, KATIE ELLEN (PAC)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ELLEN
Last Name:WINANS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 NE ST JOHNS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2573
Mailing Address - Country:US
Mailing Address - Phone:360-695-9922
Mailing Address - Fax:
Practice Address - Street 1:4421 NE ST JOHNS RD
Practice Address - Street 2:SUITE F
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2573
Practice Address - Country:US
Practice Address - Phone:360-695-9922
Practice Address - Fax:360-695-1310
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01113363A00000X
WAPA60217469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60217469OtherLICENSE
1070416OtherNCCPA NATIONAL
ORPA01113OtherOREGON MED BOARD
ORPA01113OtherOREGON MED BOARD