Wayshower LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

WAYSHOWER LLC

Practice address

21449 Roughout Rd
Redding, CA 96003-8209

Phone

(530) 262-7025

Fax

(949) 553-3834

NPI assigned

Aug 23, 2022

Organization subpart

No

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

Authorized official

Name

Stephanie Ann Peterson, PMHNP-BC

Title

Sole Member LLC Owner

Phone

(530) 262-7025

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1093434193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16590 HEITMAN RD",
            "city": "COTTONWOOD",
            "state": "CA",
            "postal_code": "960228004",
            "telephone_number": "530-262-7025",
            "fax_number": "949-553-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21449 ROUGHOUT RD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960038209",
            "telephone_number": "530-262-7025",
            "fax_number": "949-553-3834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16590 Heitman Rd",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "CA",
            "postal_code": "960228004",
            "country_code": "US",
            "telephone_number": "530-262-7025",
            "fax_number": "949-553-3834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WAYSHOWER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SOLE MEMBER LLC OWNER",
        "authorized_official_telephone_number": "530-262-7025",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.