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Katharine J Keranen

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as KATHARINE KERANEN.

Based on the most recent information from CMS, provider Katharine J Keranen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1235174236
Provider Type
Individual
Full Name
Keranen, Katharine J
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
6/17/2006
Last Updated
5/24/2022

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 494-8182

(503) 494-0028

Mailing Location

3181 SW Sam Jackson Park Rd, Mailcode Sjh-2, Portland, OR 97239-3011

(503) 494-4910

(503) 494-8368

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA01420 Oregon

Provider Identifiers

ID	Description	Issuer
ID 288680400	Description Medicaid	Issuer Unlisted Minnesota

Katharine J Keranen

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Thoms, Trisha A

Good, Paulina

Moody, Samuel

Owens, Gabriel P

Megia, Shailah

Rodgers, Dawn

Wright, Jessica Lesley

Egan, Lisa Anne

Ying, Monique M

Mesa, Kendra D