Active NPI
Kate Madden
- Other Specialist/Technologist
- Gresham, OR
National Provider Identifier
1205443298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- License
- 21477
- Practice address
- 1748 NW Fairview Dr # a
Gresham, OR 97030-3842 - Phone
- (503) 492-3910
- Fax
- (503) 674-6706
- NPI assigned
- Sep 24, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 21477 | OR | |
| Other Specialist/Technologist | 246Z00000X | 21477 | OR | Primary |
Addresses
Primary practice location
1748 NW Fairview Dr # a
Gresham, OR 97030-3842
Mailing address
1748 NW Fairview Dr # a
Gresham, OR 97030-3842
Phone (503) 724-0378
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21477 | Other | OR | LMT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21477 | OR | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600905600000",
"number": "1205443298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1748 NW FAIRVIEW DR # A",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303842",
"telephone_number": "503-724-0378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1748 NW FAIRVIEW DR # A",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303842",
"telephone_number": "503-492-3910",
"fax_number": "503-674-6706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDEN",
"first_name": "KATE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-24",
"last_updated": "2020-09-24",
"certification_date": "2020-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "OR",
"license": "21477",
"primary": false
},
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "OR",
"license": "21477",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMT",
"identifier": "21477",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.