Keystone Tides, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

KEYSTONE TIDES, PLLC

Practice address

115 E Railroad Ave Ste 203
Port Angeles, WA 98362-2925

Phone

(425) 400-8602

Fax

(425) 433-9177

NPI assigned

Mar 31, 2025

Organization subpart

No

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

Authorized official

Name

Jessica Johnson, ARNPNPI 1710504311

Title

Owner

Phone

(303) 775-0065

Specialties & licenses 4

Addresses

Locations

Practitioners 2

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

• Jessica Lee Johnson, ARNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Angeles, WA
  • NPI 1710504311

  Psychiatric/Mental Health

  NPD Authorized official
• Robert Christopher Cotner, ND

  • Naturopath
  • Port Angeles, WA
  • NPI 1760548978
  NPD (past)

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

{
    "created_epoch": "1743379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1306649884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 DEER PARK RD # 21",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983627185",
            "telephone_number": "425-400-8602",
            "fax_number": "425-433-9177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E RAILROAD AVE STE 203",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983622925",
            "telephone_number": "425-400-8602",
            "fax_number": "425-433-9177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE TIDES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-31",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-775-0065",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• R Scott Kennedy, MD
• Helen Kenoyer, CDPT
• Jon Bruce Kenyon
• Joshua Lee Kenyon
• Scott Paul Kesilis
• Anna Louise Keywood, APRN,FNP
• Cecelia Kibele, MEDICAL ASSISTANT
• Matthew Kiddle, PA
• Adam Joseph Killpack, DO
• Kim Ykema Counseling PLLC

• All providers in Port Angeles, WA
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.