NPIMap

Organization Active NPI

Illuminate NP Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Orchard Park, NY
National Provider Identifier
1003671009
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ILLUMINATE NP PSYCHIATRY
Practice address
3055 Southwestern Blvd Ste 110
Orchard Park, NY 14127-1231
Phone
(716) 903-6036
NPI assigned
Feb 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Kotarski, DNPNPI 1013470350
Title
Owner/Psychiatric Nurse Practitione
Phone
(716) 903-6036

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

3055 Southwestern Blvd Ste 110
Orchard Park, NY 14127-1231

Mailing address

3055 Southwestern Blvd Ste 110
Orchard Park, NY 14127-1231

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1003671009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 SOUTHWESTERN BLVD STE 110",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 SOUTHWESTERN BLVD STE 110",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271231",
            "telephone_number": "716-903-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE NP PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "KOTARSKI",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OWNER/PSYCHIATRIC NURSE PRACTITIONE",
        "authorized_official_telephone_number": "716-903-6036",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orchard Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.