Kathleen Gordon Wall, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003853 Issued in WA

Practice address

12607 SE Mill Plain Blvd
Vancouver, WA 98684-6055

Phone

(360) 418-6001

NPI assigned

Aug 19, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649384165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5924 NE 25TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972116132",
            "telephone_number": "503-493-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12607 SE MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846055",
            "telephone_number": "360-418-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "KATHLEEN",
        "middle_name": "GORDON",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Walker, MS, LMHC, LPC, NCC
• Rielly Laine Walker
• Theresa F. Walker, SA-C
• Tiffany Dawn Walker
• Salie Walksontop
• Nicole Christine Wall, RN
• Mary Wallace
• Skyler Wallace
• Tristin HC Wallace, ND
• Vanessa Wallace

• Medical Physician Assistant in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.