Individual
KATHLEEN RYAN PONSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 SE CHKALOV DR STE 170, VANCOUVER, WA 98683
(360) 787-7135
(360) 799-3913
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60090604
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0252790
L & I
WA
Enumeration date
06/22/2009
Last updated
06/13/2018
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