DR. KATHRYN KIM WAGGONER (NPI# 1316188121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316188121 |
| Entity Type | Individual |
| Full Name | DR. KATHRYN KIM WAGGONER |
| Other Name | KATHRYN KIM MULLIN |
| Credential | PSY.D., ABPP |
| Practice Address |
2112 Bienville Blvd Ste K Ocean Springs MS 39564-3067 |
| Practice Telephone | 2288751590 |
| Practice Fax Number | 8337791879 |
| Mailing Telephone | 2288751590 |
| Mailing Fax Number | 8337791879 |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2020-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TH0004X |
Psychologist Specialization: Health |
591032 | MS | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
7393 | DC | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
1577 | AL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 06585020 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215491303 | Kathryn Ann Waggoner | Occupational Therapy Assistant | 1024 N Bond St, Springfield, IL 62702-3729 | 2019-01-23 |
| 1881704195 | Kathryn Gibson Waggoner | Pediatrics | 125 Medical Park Ln, Suite H, Murphy, NC 28906-6920 | 2006-08-30 |
| Street Address |
2112 BIENVILLE BLVD STE K |
| City | OCEAN SPRINGS |
| State | MS |
| Zip Code | 39564-3067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093366775 | Phoenix Behavioral Health Center, Pllc | Psychologist | 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564-3067 | 2019-09-24 |
| 1952791055 | Rachel A Raley | Social Worker | 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564-3067 | 2015-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750996401 | Shelby Bourgeois | Speech-Language Pathologist | 108 Heron Park Pl, Ocean Springs, MS 39564 | 2020-09-10 |
| 1467010520 | Rachel Stephenie Knox | Student in an Organized Health Care Education/Training Program | 81mdss/gme 301 Fisher St., Rm 1g123, Keesler Afb, MS 39564 | 2019-06-04 |
| 1457839292 | Polly Anne Lampon | Registered Nurse | 2301 Rue Beaux Chenes, Ocean Springs, MS 39564 | 2018-08-03 |
| 1578062725 | Gulf Coast Sleep Medicine LLC | Clinic/Center | 2112 Bienville Blvd., Suite P, Ocean Springs, MS 39564 | 2018-02-02 |
| 1598212623 | Edward Victor Brown Jr. | Dentist | 15465 Oak Lane, Gulfport, MS 39564 | 2016-09-07 |
| 1386016749 | L. Randy Buntyn, D.m.d., Pllc | Dentist | 1203 Government St., Ocean Springs, MS 39564 | 2015-10-26 |
| 1467835629 | Msmobileyes Inc. | Optometrist | 2510 Bileville Blvd, Ocean Springs, MS 39564 | 2015-07-07 |
| 1659760999 | Clark Jamison Levi | Pharmacist | 1019 Government Street Suite F & D, Ocean Springs, MS 39564 | 2015-01-09 |
| 1932545480 | Therese Anne Hanna | Nurse Practitioner | 6900 Washington Avenue, Ocean Springs, MS 39564 | 2013-05-10 |
| 1346589421 | Jennah Claine Ladner | Nurse Practitioner | 1137 Ocean Springs Road, Ocean Springs, MS 39564 | 2013-02-08 |
| Find all providers in zip 39564 | ||||
| Taxonomy Code | 103TH0004X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health |
| The distinct focus of the clinical health psychologist is on physical health problems. A clinical health psychologist has special expertise or training in clinical health psychology and applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to the promotion and maintenance of health; the prevention, treatment and rehabilitation of illness and disability; and the improvement of the health care system. Clinical health psychologists are dedicated to the development of knowledge regarding the interface between behavior and health, and to the delivery of high quality services based on that knowledge to individuals, families, and health care. |
| Notes: Source: American Psychological Association Commission for the Recognition of Specialties and Proficiencies in Professional Psychology, 2008. [1/1/2007: new, 7/1/2008: definiton added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093366775 | Phoenix Behavioral Health Center, Pllc | Psychologist | 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564-3067 | 2019-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891003331 | Geralyn Datz Phd | Psychologist | 502 Court St, Hattiesburg, MS 39401-3944 | 2010-09-17 |
| City | OCEAN SPRINGS |
| Zip Code | 39564 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.