{
"Npi": {
"NPI": "1518034180",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "N.W. PEDIATRIC CENTER INC PS",
"ParentOrgTIN": null,
"OrgName": "N W PEDIATRIC CENTER INC P S",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1911 COOKS HILL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CENTRALIA",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98531-9073",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-736-6778",
"MailingAddressFaxNumber": "360-736-6552",
"FirstLinePracticeLocationAddress": "1911 COOKS HILL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CENTRALIA",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98531-9073",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-736-6778",
"PracticeLocationAddressFaxNumber": "360-736-6552",
"EnumerationDate": "11/29/2006",
"LastUpdateDate": "10/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCKAY",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "GAIL",
"AuthorizedOfficialTitle": "PRACTICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "360-736-6778",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "AP30007039",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00028578",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "AP60086265",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00027525",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00038226",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0804X",
"TaxonomyName": "Child & Adolescent Psychiatry Physician",
"LicenseNumber": "MD00039351",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00032554",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00043677",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "AP30006273",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00029916",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
]
}
}
}