Provider Demographics
NPI:1174047393
Name:MASON-ELLIS, KATHARINE M (PA-C)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:M
Last Name:MASON-ELLIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:M
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10151 SE SUNNYSIDE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5705
Mailing Address - Country:US
Mailing Address - Phone:503-659-0880
Mailing Address - Fax:
Practice Address - Street 1:10151 SE SUNNYSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5705
Practice Address - Country:US
Practice Address - Phone:503-659-0880
Practice Address - Fax:503-513-7425
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60779453363A00000X
ORPA202574363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant