Kristine Rae Vandermark Powell, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY00002568 Issued in WA

Practice address

1800 Cooper Point Rd SW
BLDG 17
Olympia, WA 98502-1178

Phone

(360) 352-4602

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477601789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7825 CANTERWOOD DR SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985136520",
            "telephone_number": "360-459-3447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 COOPER POINT RD SW",
            "address_2": "BLDG 17",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021178",
            "telephone_number": "360-352-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "KRISTINE",
        "middle_name": "RAE VANDERMARK",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WA",
            "license": "PY00002568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PY00002568",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L AND I",
            "identifier": "0157189",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clare Posto
• Ashley Potter
• Kayla Jean Potts
• Tiong Hian Pouw, MD
• John Bradford Powell, PH.D.
• Morgan Vanessa Powell
• Susan Lisker Powell, MD
• Kelley Ann Powers, AUD
• Mary Leann Powers, B.A., L.M.P., SOMA
• Tracie Michelle Powney, OTRL, LMHC, LMFTA

• Clinical Neuropsychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Clinical Neuropsychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.