Katies Way Anchorage LLC

Primary specialty

Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X

Legal business name

KATIES WAY ANCHORAGE LLC

Doing business as

KATIES WAY

Practice address

2751 Debarr Rd Ste 300
Anchorage, AK 99508-2962

Phone

(907) 206-4088

Fax

(907) 318-9956

NPI assigned

Feb 22, 2023

Organization subpart

No

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

Authorized official

Name

Kelly Rae Johnson

Title

Credentialing Director

Phone

(785) 320-6616

Specialties & licenses 15

Addresses

Other names 1

• KATIES WAY Doing business as

Locations

Practitioners 2

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

• Caleb Lee Jordan

  • Psychiatry Physician
  • Roslindale, MA
  • NPI 1619361904
  NPD (past)
• Mark Landon Millwood, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bedford, NH
  • NPI 1437725058
  NPD (past)

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1215635875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 POYNTZ AVE APT B",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665026355",
            "telephone_number": "785-320-6616",
            "fax_number": "907-318-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 DEBARR RD STE 300",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995082962",
            "telephone_number": "907-206-4088",
            "fax_number": "907-318-9956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12001 Business Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Eagle River",
            "state": "AK",
            "postal_code": "995777743",
            "country_code": "US",
            "telephone_number": "907-206-4088",
            "fax_number": "907-318-9956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KATIES WAY ANCHORAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-22",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "785-320-6616"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KATIES WAY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nathan Kasukonis, D.O.
• Martin Peter Kaszubowski, M.D.
• Brent Katchatag
• Kathleen Corleto
• Christine Kathmann, RPH
• Katmai Oncology Group, LLC
• Katmai Professional Services Group, LLC
• Katya Kennedy Counseling LLC
• Deborah Sue Katz Lackey, RN
• Howard L Katz, MD

• Behavioral Neurology & Neuropsychiatry Physician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Behavioral Neurology & Neuropsychiatry Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.