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DR. KATHRYN KIM WAGGONER PSY.D., ABPP
NPI 1316188121
Psychologist - Health in Ocean Springs, MS

Active since March 09, 2009PECOS Enrolled
2112 BIENVILLE BLVD STE K, OCEAN SPRINGS, MS 39564(228) 819-2171(228) 205-4986 Get Directions Write a Review

NPPES record last updated: June 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 10, 2024, Feb 1, 2022, May 20, 2021 and 3 more (6 updates tracked since 2018).

About Dr. Kathryn Kim Waggoner Psy.d., Abpp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KATHRYN KIM WAGGONER PSY.D., ABPP (NPI 1316188121) is an individual health provider in Ocean Springs, Mississippi, licensed in Mississippi (591032) and active in the NPI registry since March 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1316188121
Entity TypeIndividualFemale
Primary Taxonomy103TH0004X
Provider Legal NameDR. KATHRYN KIM WAGGONERCredential: PSY.D., ABPP
Location Address2112 BIENVILLE BLVD STE KOcean Springs, MS 39564-3067
Mailing Address2112 Bienville Blvd Ste KOcean Springs, MS 39564-3067 · (228) 819-2171 · Fax (833) 779-1879
Phone(228) 819-2171
Fax(228) 205-4986
Sole ProprietorNo
Enumeration DateMarch 9, 2009
Last NPPES UpdateJune 10, 20246 updates tracked since enumeration
NPPES CertifiedAugust 8, 2022
✔ NPI 1316188121 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · HealthBehavioral Health & Social Service Providers
Taxonomy Code103TH0004X
Licenses✔ Licensed in MS · 591032✔ Licensed in AL · 1577
Definition
A psychologist who specializes in clinical health psychology that investigates and implements clinical services across diverse populations and settings to promote health and well-being and to prevent, treat, and manage illness and disability. Clinical health psychology sees health as the confluence of psychological, social, cultural, and biological factors and applies this understanding to professional activities including:
2112 BIENVILLE BLVD STE K, Ocean Springs, MS 39564
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Other Names 1

Former Name (1)Kathryn Kim Mullin

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kathryn Kim Waggoner Psy.d., Abpp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kathryn Waggoner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Phoenix Behavioral Health Center, PLLC
Same address
Health
2112 BIENVILLE BLVD STE K
Ocean Springs, MS 39564
  • Reassigned Medicare billing, Mississippi enrollment
  • 4 clinicians in this Medicare group
NPI 1093366775 (228) 819-2171

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SUZANNE MARIE GANSCHOW LPC, CAADC, BC-TMH
Counselor
2112 BIENVILLE BLVD STE K
OCEAN SPRINGS, MS 39564
Jackson County (228) 819-2171
PHOENIX BEHAVIORAL HEALTH CENTER, PLLC
Psychologist (Health)
2112 BIENVILLE BLVD STE K
OCEAN SPRINGS, MS 39564
Jackson County (228) 819-2171
AMY E WILKINSON M.ED., LPC
Counselor (Professional)
2112 BIENVILLE BLVD STE K
OCEAN SPRINGS, MS 39564
Jackson County (228) 819-2171
SHELBY LYNN REEVES LPC
Counselor
2112 BIENVILLE BLVD STE K
OCEAN SPRINGS, MS 39564
Jackson County (228) 819-2171
MS. RACHEL A RALEY LMSW
Social Worker
2112 BIENVILLE BLVD STE K
OCEAN SPRINGS, MS 39564
Jackson County (228) 875-1590

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathryn Waggoner's NPI number?

The NPI number for Kathryn Waggoner is 1316188121. It was assigned to this individual provider in the NPPES registry on March 9, 2009. The provider is also known as Kathryn Kim Mullin.

Where is Kathryn Waggoner located?

Kathryn Waggoner practices at 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564. The listed phone number is (228) 819-2171.

What is Kathryn Waggoner's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Health, with taxonomy code 103TH0004X.

Is Kathryn Waggoner enrolled in Medicare?

Yes. Kathryn Waggoner is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kathryn Waggoner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathryn Waggoner reassigns Medicare benefits to Phoenix Behavioral Health Center, PLLC (Ocean Springs, MS). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathryn Waggoner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kathryn Waggoner was last updated on June 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.