Cheryl Dawn Koenig, LMP

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

MA60471828 Issued in WA

Practice address

118 N Liberty St
Apt a
Port Angeles, WA 98362-4322

Phone

(360) 457-7379

Fax

(360) 457-8717

NPI assigned

Dec 8, 2014

Last updated

Dec 8, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Gateway Therapeutic Massage

  • Preferred Provider Organization
  • Port Angeles, WA
  • NPI 1255659066
  NPD (past)

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1952709941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 121",
            "city": "JOYCE",
            "state": "WA",
            "postal_code": "983430121",
            "telephone_number": "309-258-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N LIBERTY ST",
            "address_2": "APT A",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624322",
            "telephone_number": "360-457-7379",
            "fax_number": "360-457-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "CHERYL",
        "middle_name": "DAWN",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-08",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "WA",
            "license": "MA60471828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE THERAPY",
            "identifier": "MA 60471828",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julianne Diana Knezovich, PA-C
• Robert Lowell Knipple, D.D.S.
• Amanda Knobel
• Julie K Knobel, LICSW
• Kevin Ross Koelsch, SUDPT
• Sarah Camile Komatsu, MS, MHP, LMHC
• John Kopp
• Betsy L Kott-Flodstrom, MD
• Bradley Mark Krall, PA-C
• Kayla Elizabeth Kressler

• Community Health Worker in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Community Health Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.