Provider Demographics
NPI:1629884143
Name:KATIES WAY JUNCTION CITY
Entity type:Organization
Organization Name:KATIES WAY JUNCTION CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-320-5000
Mailing Address - Street 1:206 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-1439
Mailing Address - Country:US
Mailing Address - Phone:857-751-1287
Mailing Address - Fax:785-530-6641
Practice Address - Street 1:206 E ASH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-1439
Practice Address - Country:US
Practice Address - Phone:857-751-1287
Practice Address - Fax:785-530-6641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATIE'S WAY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty