Kimberly Saphaire-Dawn Wyatt, AAC, BA

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG 60687237 Issued in WA

Practice address

209 Milwaukee St
Mount Vernon, WA 98273

Phone

(360) 419-7574

Fax

(360) 428-4354

NPI assigned

Dec 12, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1194269019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 MILWAUKEE ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "98273",
            "telephone_number": "360-419-7574",
            "fax_number": "360-428-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 MILWAUKEE ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "98273",
            "telephone_number": "360-419-7574",
            "fax_number": "360-428-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "KIMBERLY",
        "middle_name": "SAPHAIRE-DAWN",
        "name_prefix": "Ms.",
        "credential": "AAC, BA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-12",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG 60687237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kirsten Elizabeth Young

• Counselor in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; 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.