Lorie Ann Nellenback, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402660-01 Issued in NY

Practice address

1330 County Road 132
Ovid, NY 14521-9700

Phone

(315) 835-6136

NPI assigned

Feb 10, 2020

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dick Van Dyke Addiction Treatment Center

  • Community/Behavioral Health Agency
  • Ovid, NY
  • NPI 1730274937
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 10, 2020.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1043842867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "WEEDSPORT",
            "state": "NY",
            "postal_code": "131660421",
            "telephone_number": "315-406-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 COUNTY ROAD 132",
            "city": "OVID",
            "state": "NY",
            "postal_code": "145219700",
            "telephone_number": "315-835-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLENBACK",
        "first_name": "LORIE",
        "middle_name": "ANN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402660-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen M Hey, NP
• Rebeca Kiser, RN
• KPH Healthcare Services, Inc.
• Lindsey Morgan Licak, R.N.
• Kamran Mirshahi, DC
• Palmer Pharmacy Inc
• David James Palmer, R.PH.
• Marnie Pealo
• Kimberly Ann Pitkin, LPN
• Heather Reed

• All providers in Ovid, NY
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.