Provider Demographics
| NPI: | 1205573425 |
|---|---|
| Name: | KATIES WAY KILLEEN PLLC |
| Entity type: | Organization |
| Organization Name: | KATIES WAY KILLEEN PLLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF CREDENDIALING |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KELLY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JOHNSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | DIRECTOR OF BILLING |
| Authorized Official - Phone: | 785-320-6616 |
| Mailing Address - Street 1: | 2025 MEMORY LN STE 500 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HARKER HEIGHTS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 76548-7489 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 806-810-0585 |
| Mailing Address - Fax: | 806-517-2667 |
| Practice Address - Street 1: | 2025 MEMORY LN STE 500 |
| Practice Address - Street 2: | |
| Practice Address - City: | HARKER HEIGHTS |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 76548-7489 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 806-810-0585 |
| Practice Address - Fax: | 806-517-2667 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-05-18 |
| Last Update Date: | 2024-11-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SF0001X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | Group - Multi-Specialty |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 202D00000X | Allopathic & Osteopathic Physicians | Integrative Medicine | Group - Multi-Specialty | |
| No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
| No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | T6078 | Other | LICENSE |
