Katies Way Dupont

Primary specialty

Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X

Legal business name

KATIES WAY DUPONT

Doing business as

Katies Way

Practice address

1175 Center Dr Ste 130
Dupont, WA 98327-7733

Phone

(253) 260-6521

Fax

(253) 397-3443

NPI assigned

Dec 9, 2024

Organization subpart

Yes

Parent organization

KATIES WAY TACOMA, LLCAs reported in NPPES

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 1

Addresses

Other names 1

• Katies Way Doing business as

Tax ID family

Katies Way Tacoma LLC2 organizations share this tax ID, including this one

Part of

Katies Way Tacoma LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Katie'S Way Tacoma, LLC

  • Behavioral Neurology & Neuropsychiatry Physician
  • Tacoma, WA
  • NPI 1285405522
  NPD tax ID

Locations

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1518773035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 CENTER DR STE 130",
            "city": "DUPONT",
            "state": "WA",
            "postal_code": "983277733",
            "telephone_number": "253-260-6521",
            "fax_number": "253-397-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 CENTER DR STE 130",
            "city": "DUPONT",
            "state": "WA",
            "postal_code": "983277733",
            "telephone_number": "253-260-6521",
            "fax_number": "253-397-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATIES WAY DUPONT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KATIES WAY TACOMA, LLC",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "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": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katies Way",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Johnson Maria Friederike Johnson, LMP
• Alexandria Grey Jordan
• Michelle Kathryn Kaerstner
• Debbie Kahalewai
• Aynngel Kamu
• Andrew Jay Kelly
• Jordan Kelso
• Amanda Jean Kilborn
• Hunter Kiphart
• Elizabeth Klein, LSWAIC

• Behavioral Neurology & Neuropsychiatry Physician in Dupont, WA
• Providers in Dupont, WA by specialty
• Behavioral Neurology & Neuropsychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.