| Doctor Name: | KATHLEEN RYAN PONSFORD |
| NPI Number: | 1053548669 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA60090604 |
| Business Practice Address: | 2005 W Main St Battle Ground, WA - 986044311 |
| Business Phone Number: | 3608822778 |
| Business Fax Number: | 3606041690 |
| Mailing Address: | 700 Ne 87th Ave, VANCOUVER |
| State: | WA |
| Postal Code: | 986641913 |
| Phone Number: | 3608822778 |
| Fax Number: | 3606041761 |
| NPI Enumeration Date: | 06/22/2009 |
| NPI Last Update Date: | 06/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA60090604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |