Katherine A Bagwell, RD, CSO, LD
Individual provider Active NPI Registered Dietitian · Portland, OR
NPI 1447747951 · NPPES record last updated Apr 19, 2018
Key facts
- NPI
- 1447747951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 000981 (OR)
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011 - Phone
- (503) 418-9731
- NPI assigned
- Apr 19, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000981 | OR | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 000981 | OR | Yes |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Mailing address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Other providers in Portland, OR
- Ted Bagley
- Olivia Marie Bagot
- Anthony Bagoyo
- Alexis Kari Bagwell
- Anne Fraser Bagwell
- Lauren Lee Bah
- Omar Bah
- Bahandi Inc. Dba Comfort Keepers
- Alistair Bahar
- Denise Mirel Bahena
All providers in Portland, OR · Registered Dietitian in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.