Chrysalis Psychiatry | NPI 1104648732

Key facts

NPI: 1104648732
Entity type: Organization (NPI type 2)
Primary specialty: Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Legal business name: CHRYSALIS PSYCHIATRY
Practice address: 1001 Water St # 1009
Port Townsend, WA 98368-6705
Phone: (206) 279-4547
NPI assigned: Oct 25, 2024
Organization subpart: No

Authorized official

Name: Anne Elizabeth Koomen, ARNP NPI 1629351317
Title: Owner
Phone: (415) 847-4643

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

Anne Elizabeth Koomen, ARNP Psychiatric/Mental Health Nurse Practitioner · Port Townsend, WA · NPI 1629351317

NPD Authorized official PSYCHIATRIC/MENTAL HEALTH

National Provider Directory

Locations

1001 Water St
#1009
Port Townsend, WA 98368
Phone (206) 279-4547

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychiatric/Mental Health Nurse Practitioner Group: 193200000X MULTI-SPECIALTY GROUP	363LP0808X			Yes

Addresses

Primary practice location

1001 Water St # 1009
Port Townsend, WA 98368-6705

Mailing address

PO Box 1093
Port Townsend, WA 98368-1093
Phone (206) 279-4547

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 25, 2024.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1104648732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1093",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983681093",
            "telephone_number": "206-279-4547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WATER ST # 1009",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983686705",
            "telephone_number": "206-279-4547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALIS PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "KOOMEN",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-847-4643",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

All providers in Port Townsend, WA · Psychiatric/Mental Health Nurse Practitioner in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.