Individual provider · Type 1 NPI

Kathleen Gordon Wall, PA-C

Medical Physician Assistant · Vancouver, WA

NPI number 1649384165 Active

Practice location

12607 SE Mill Plain Blvd
Vancouver, WA 98684-6055

Call (360) 418-6001 Map

Mailing address

5924 NE 25th Ave
Portland, OR 97211-6132

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA10003853 (WA)

Medical Physician Assistant: Definition to come...

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About NPI 1649384165

Kathleen Gordon Wall, PA-C's National Provider Identifier is 1649384165, issued on Aug 19, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Vancouver, WA. The record was last updated on Jul 8, 2007.