Provider Demographics
NPI:1619013000
Name:CATES, CORAL J (ARNP)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:J
Last Name:CATES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 EXCHANGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3364
Mailing Address - Country:US
Mailing Address - Phone:503-325-0241
Mailing Address - Fax:503-861-2043
Practice Address - Street 1:2120 EXCHANGE ST STE 301
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3364
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-861-2043
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003634363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631631Medicaid
OR201406323CNS-PPOtherOR LICENSE
WAAP30003634OtherSTATE LICENCE
WAAP30003634OtherSTATE LICENCE
WA9631631Medicaid