Provider Demographics
NPI:1891363719
Name:ATOMIC2 DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:ATOMIC2 DERMATOLOGY PLLC
Other - Org Name:ATOMIC DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-233-7546
Mailing Address - Street 1:9221 SANDIFUR PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9241
Mailing Address - Country:US
Mailing Address - Phone:509-430-6339
Mailing Address - Fax:509-795-3508
Practice Address - Street 1:105 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2848
Practice Address - Country:US
Practice Address - Phone:509-240-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2089475Medicaid