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Organization
KEYSTONE TIDES, PLLC
Active
Organization
KEYSTONE TIDES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA JOHNSON ARNP (OWNER)
(303) 775-0065
Entity
Organization
Contact information
Practice address
115 E RAILROAD AVE STE 203, PORT ANGELES, WA 98362-2925
(425) 400-8602
(425) 433-9177
Mailing address
132 DEER PARK RD # 21, PORT ANGELES, WA 98362-7185
(425) 400-8602
(425) 433-9177
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/31/2025
Last updated
03/31/2025
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