NPIMap

Organization Active NPI

Atomic2 Dermatology PLLC

Doing business as Atomic Dermatology

  • Nurse Practitioner
  • Walla Walla, WA
National Provider Identifier
1891363719
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ATOMIC2 DERMATOLOGY PLLC
Doing business as
Atomic Dermatology
Practice address
105 S 3Rd Ave
Walla Walla, WA 99362-2848
Phone
(509) 240-2554
NPI assigned
Jun 16, 2021
Last updated
Jan 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Authorized official

Name
Jo Kiehn
Title
Administrator
Phone
(509) 233-7546

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

105 S 3Rd Ave
Walla Walla, WA 99362-2848

Mailing address

9221 Sandifur Pkwy Ste a
Pasco, WA 99301-9241
Phone (509) 430-6339

Other names 1

  • ATOMIC DERMATOLOGY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL atomicderm.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240611000741 WA Part B Supplier - Clinic/Group Practice 2769924307 Receives reassigned benefits from 5 practitioners
Practice locations: Walla Walla, WA

National Provider Directory

National Provider Directory

Locations

9221 Sandifur Pkwy
Pasco, WA 99301
Phone (509) 233-7546

9221 Sandifur Pkwy
Ste A
Pasco, WA 99301
Phone (509) 233-7546

103 E Poplar St
Walla Walla, WA 99362

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1891363719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9221 SANDIFUR PKWY STE A",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993019241",
            "telephone_number": "509-430-6339",
            "fax_number": "509-795-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S 3RD AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622848",
            "telephone_number": "509-240-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATOMIC2 DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "KIEHN",
        "authorized_official_first_name": "JO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-233-7546"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "atomicderm.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "105 S 3rd Ave",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993622848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ATOMIC DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ATOMIC DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.