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General NPI Number Information
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NPI Number | 1518773035
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Entity Type | Organization
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Legal Business Name | KATIES WAY DUPONT
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1175 CENTER DR STE 130
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City | DUPONT
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State | WA
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Zip | 98327-7733
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Country | US
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Telephone | 253-260-6521
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Fax | 253-397-3443
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Provider Business Mailing Address
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Address Line | 1175 CENTER DR STE 130
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City | DUPONT
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State | WA
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Zip | 98327-7733
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Country | US
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Telephone | 253-260-6521
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Fax | 253-397-3443
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | KELLY RAE JOHNSON
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Credential |
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Telephone | 785-320-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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