NPIMap

Individual provider Active NPI

Kenyacktie Hartshorn, PSY.D.

  • Clinical Psychologist
  • Burien, WA
National Provider Identifier
1144510942
Registry record updated Dec 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY60212285 Issued in WA
Practice address
16251 Sylvester Rd SW
Burien, WA 98166-3017
Phone
(253) 226-1369
NPI assigned
Apr 13, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Development & Aging Psychologist 103TA0700X PY60212285 WA
Clinical Psychologist 103TC0700X PY60212285 WA Primary
Psychologist 103T00000X PY60212285 WA

Addresses

Primary practice location

16251 Sylvester Rd SW
Burien, WA 98166-3017

Mailing address

PO Box 25173
Federal Way, WA 98093-2173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120904000680 WA Practitioner - Clinical Psychologist 2668629239 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center Current Accepting new patients
Virginia Mason Medical Center CurrentSince Sep 1, 2025 Accepting new patients
Franciscan Medical Group CurrentSince Feb 1, 2017 Accepting new patients
Virginia Mason Medical Center CurrentSince Sep 1, 2025 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Commonspirit Washington Past Accepting new patients
Cascade Mental Health PS PastSince Jan 1, 2006 Accepting new patients
Saint Clare Hospital Past Accepting new patients

Locations

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

16251 Sylvester Rd SW
Burien, WA 98166
Phone (206) 244-9970

34515 9th Ave S
Federal Way, WA 98003
Phone (253) 835-8100

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

1717 S J St
Fl 11
Tacoma, WA 98405
Phone (253) 426-6691

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480723200000",
    "number": "1144510942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25173",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980932173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16251 SYLVESTER RD SW",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981663017",
            "telephone_number": "253-226-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTSHORN",
        "first_name": "KENYACKTIE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2016-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "WA",
            "license": "PY60212285",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60212285",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60212285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burien, WA

Sources for this page

Verify at the official NPI Registry.