Atomic2 Dermatology PLLC
Organization Active NPI Nurse Practitioner · Walla Walla, WA
NPI 1891363719 · NPPES record last updated Jan 9, 2023
Key facts
- NPI
- 1891363719
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- ATOMIC2 DERMATOLOGY PLLC
- Practice address
- 105 S 3Rd Ave
Walla Walla, WA 99362-2848 - Phone
- (509) 240-2554
- NPI assigned
- Jun 16, 2021
- Organization subpart
- No
Authorized official
- Name
- Jo Kiehn
- Title
- Administrator
- Phone
- (509) 233-7546
Practitioners 5
-
Lauren K Berg, ARNP
-
Kristi Lynn Guzman, ARNP
-
Jessica Meredith, ARNP
-
Marla Kae Stahlnecker, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240611000741 | WA | Part B Supplier - Clinic/Group Practice | 2769924307 |
Receives reassigned benefits from 5 practitioners Practice locations: Walla Walla, WA |
National Provider Directory
Locations
9221 Sandifur Pkwy
Pasco, WA 99301
Phone (509) 233-7546
103 E Poplar St
Walla Walla, WA 99362
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | |||
| Nurse Practitioner |
363L00000X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2089475 | Medicaid | WA |
Other names
- ATOMIC DERMATOLOGY
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | atomicderm.com | Direct |
Other providers in Walla Walla, WA
- Donald K Ashley
- Shirley H Ashley
- Assisted Living Concepts Inc
- Assisted Living Concepts, LLC
- Jill Atchison
- Victor Keeno Attoh
- Janet Claire Atwater
- Julian Aurigui
- Kathryn Jane Austin
- Tiffany Auxier
All providers in Walla Walla, WA · Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.