NPIMap

Organization Active NPI

Divinity LLC

Doing business as Divinity

  • Psychiatry Physician
  • Loon Lake, WA
National Provider Identifier
1013803360
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DIVINITY LLC
Doing business as
Divinity
Practice address
3957 Garden Spot Rd
Loon Lake, WA 99148-9750
Phone
(509) 990-9416
NPI assigned
Jun 14, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristin Kenyon-Miller, ARNP
Title
Owner
Phone
(509) 990-9416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3957 Garden Spot Rd
Loon Lake, WA 99148-9750

Mailing address

PO Box 1037
Loon Lake, WA 99148-1037
Phone (509) 990-9416

Other names 1

  • Divinity Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1013803360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1037",
            "city": "LOON LAKE",
            "state": "WA",
            "postal_code": "991481037",
            "telephone_number": "509-990-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3957 GARDEN SPOT RD",
            "city": "LOON LAKE",
            "state": "WA",
            "postal_code": "991489750",
            "telephone_number": "509-990-9416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-14",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "KENYON-MILLER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-990-9416",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divinity",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loon Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.