Mind and Soul Psychiatry

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MIND AND SOUL PSYCHIATRY

Practice address

2505 Miner St
Idaho Springs, CO 80452-5112

Phone

(720) 587-9702

NPI assigned

Jul 8, 2022

Organization subpart

No

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

Authorized official

Name

Jennifer Medina, APRN-MSNNPI 1902422801

Title

Pmhnp-BC

Phone

(720) 587-9702

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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

• Jennifer Medina, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Spokane, WA
  • NPI 1902422801
  NPD Authorized official

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1053044701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 MINER ST # 1926",
            "city": "IDAHO SPRINGS",
            "state": "CO",
            "postal_code": "804525112",
            "telephone_number": "720-587-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 MINER ST",
            "city": "IDAHO SPRINGS",
            "state": "CO",
            "postal_code": "804525112",
            "telephone_number": "720-587-9702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND AND SOUL PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PMHNP-BC",
        "authorized_official_telephone_number": "720-587-9702",
        "authorized_official_credential": "APRN-MSN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifermedina@mindandsoulpsychiatry.com",
            "affiliation": "N",
            "address_1": "2505 Miner St",
            "city": "Idaho Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "804525112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Idaho Springs, CO
• Providers in Idaho Springs, CO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.