Healthcare Provider Details

I. General information

NPI: 1467362160
Provider Name (Legal Business Name): WILL KOENIG, PMHNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187A TUCKER RD
ETHEL WA
98542-9704
US

IV. Provider business mailing address

PO BOX 753
TOLEDO WA
98591-0753
US

V. Phone/Fax

Practice location:
  • Phone: 360-827-5362
  • Fax: 360-978-5925
Mailing address:
  • Phone: 360-827-5362
  • Fax: 360-978-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S KOENIG
Title or Position: PMHNP
Credential: ARNP
Phone: 360-827-5362