Individual
KATHLEEN S PICKERING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1620 E 12TH ST, THE DALLES, OR 97058
(541) 296-9151
(541) 296-4710
Mailing address
1750 12TH ST, HOOD RIVER, OR 97031-9540
(541) 386-5070
(541) 386-7190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01211
OR
363AM0700X
Medical Physician Assistant
469
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218112
—
OR
Enumeration date
01/24/2007
Last updated
11/03/2017
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