Provider Demographics
NPI:1023842051
Name:PACIFIC NORTHWEST PHYSICIAN PSYCHIATRIC CARE PLLC
Entity type:Organization
Organization Name:PACIFIC NORTHWEST PHYSICIAN PSYCHIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-721-6002
Mailing Address - Street 1:2704 E GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8502
Mailing Address - Country:US
Mailing Address - Phone:573-721-6002
Mailing Address - Fax:
Practice Address - Street 1:2704 E GOLDEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8502
Practice Address - Country:US
Practice Address - Phone:573-721-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty