Kathryn Kim Waggoner, PSY.D., ABPP

Primary specialty

Health PsychologistTaxonomy code 103TH0004X

License

591032 Issued in MS

Practice address

2112 Bienville Blvd Ste K
Ocean Springs, MS 39564-3067

Phone

(228) 819-2171

Fax

(228) 205-4986

NPI assigned

Mar 9, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kathryn Kim Mullin Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Phoenix Behavioral Health Center, PLLC

  • Health Psychologist
  • Ocean Springs, MS
  • NPI 1093366775
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1236556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1316188121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 BIENVILLE BLVD STE K",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643067",
            "telephone_number": "228-819-2171",
            "fax_number": "833-779-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 BIENVILLE BLVD STE K",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643067",
            "telephone_number": "228-819-2171",
            "fax_number": "228-205-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "KATHRYN",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "PSY.D., ABPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-09",
        "last_updated": "2024-06-10",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "AL",
            "license": "1577",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MS",
            "license": "591032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "MULLIN",
            "middle_name": "KIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vascular Specialists of Mobile, P.C.
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• Michele J. Velez, SLP
• Lori Leanne Virgilio, FNP
• William K Wade, BOCP, COF, C.PED.
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Anna Walker, SLP

• Health Psychologist in Ocean Springs, MS
• Providers in Ocean Springs, MS by specialty
• Health Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.