Active NPI
Kenneth R Roughton, PHD
- Clinical Psychologist
- Dayton, WA
National Provider Identifier
1124178090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00002083
- Practice address
- 221 E Washington Ave
Dayton, WA 99328-1317 - Phone
- (509) 382-1164
- Fax
- (509) 382-1166
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00002083 | WA | Primary |
Addresses
Primary practice location
221 E Washington Ave
Dayton, WA 99328-1317
Mailing address
511 E Race St
Dayton, WA 99328-1646
Phone (509) 382-1383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00002083 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1124178090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 E RACE ST",
"city": "DAYTON",
"state": "WA",
"postal_code": "993281646",
"telephone_number": "509-382-1383",
"fax_number": "509-382-1166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 E WASHINGTON AVE",
"city": "DAYTON",
"state": "WA",
"postal_code": "993281317",
"telephone_number": "509-382-1164",
"fax_number": "509-382-1166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUGHTON",
"first_name": "KENNETH",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00002083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.