| Specialty | Taxonomy Code | |
|---|---|---|
| * | Psychiatric/Mental Health, Child & Family | 364SP0810X |
| Athletic Trainer | 2255A2300X | |
| Psychiatric/Mental Health | 163WP0808X |
* Indicates primary specialty
| NPI Number | 1164767471 |
| Credentials | PMHNP-BC (Adult Psychiatric-Mental Health Nurse Practitioner) |
| Entity | Individual |
| Enumeration date | 11/28/2012 |
| Last updated | 10/26/2023 - About 3 years ago |
| Sole proprietor1 | No |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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