Individual ProviderKathleen RafteryPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address200 NE Mother Joseph Pl Ste 330, Vancouver, WA 98664-3288(360) 514-2990PECOS EnrollmentBased on the most recent information from CMS, provider Kathleen Raftery is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1932560448Provider TypeIndividualFull NameRaftery, KathleenGenderFemaleSole ProprietorYesEnumeration Date3/10/2016Last Updated5/1/2024Contact InformationPractice LocationPractice Address200 NE Mother Joseph Pl Ste 330, Vancouver, WA 98664-3288Phone(360) 514-2990Fax(360) 514-3508Mailing LocationMailing Address4438 Hideaway Pl, La Mesa, CA 91941-6800PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AS0400XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMED-PAC-LIC-91166MontanaCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseMED-PAC-REG-0001782MontanaCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA61285554Washington