Erica Wall, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Chatham, NY
NPI 1083152136 · NPPES record last updated May 31, 2023
Key facts
- NPI
- 1083152136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 404981 (NY)
- Practice address
- 23 High St
Chatham, NY 12037-1127 - Phone
- (518) 364-5854
- NPI assigned
- Feb 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Columbia County
Practice addresses (Care Compare)
325 Columbia St
Suite 300
Hudson, NY 12534-1931
Phone (518) 828-9446
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230906001610 | NY | Practitioner - Nurse Practitioner | 7618330895 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 404981 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia County | Current |
Accepting new patients | |
| Columbia County | Current |
Accepting new patients |
Locations
325 Columbia St
Ste 300
Hudson, NY 12534
Phone 51882894461213
325 Columbia St
Hudson, NY 12534
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 404981 | NY | Yes |
Addresses
Primary practice location
23 High St
Chatham, NY 12037-1127
Mailing address
23 High St
Chatham, NY 12037-1127
Phone (518) 364-5854
Other providers in Chatham, NY
All providers in Chatham, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.