Individual provider Active NPI

Mary Grace Carlisle, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Westerville, OH
National Provider Identifier
1104524875
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0033321 Issued in OH
Practice address
670 Meridian Way Ste 165
Westerville, OH 43082-2302
Phone
(614) 906-3223
NPI assigned
Feb 21, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0033321 OH Primary

Addresses

Primary practice location

670 Meridian Way Ste 165
Westerville, OH 43082-2302

Mailing address

670 Meridian Way Ste 165
Westerville, OH 43082-2302
Phone (614) 906-3223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230406002444 OH Practitioner - Nurse Practitioner 7517332430 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Woodstream WellnessGroup PAC ID 8527462506, 55 clinicians

Practice addresses (Care Compare)

9049 Springboro Pike
Miamisburg, OH 45342-4926
Phone (937) 759-0545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0033321OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
WS Wellness LLC Psychiatric/Mental Health CurrentSince Feb 1, 2023 Accepting new patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Dec 31, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

1911 Old Fairfield Rd
Ste 310
Beavercreek, OH 45432
Phone (937) 759-0545

3330 Erie Ave
Ste 7
Cincinnati, OH 45208
Phone (937) 759-0545

4449 Easton Way
Fl 2
Columbus, OH 43219
Phone (614) 565-8197

9049 Springboro Pike
Ste A
Miamisburg, OH 45342
Phone (937) 759-0545

9049 Springboro Pike
Miamisburg, OH 45342
Phone (937) 759-0545

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1104524875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MERIDIAN WAY STE 165",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430822302",
            "telephone_number": "614-906-3223",
            "fax_number": "614-639-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 MERIDIAN WAY STE 165",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430822302",
            "telephone_number": "614-906-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "MARY",
        "middle_name": "GRACE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-21",
        "last_updated": "2025-08-05",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "0033321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westerville, OH

Sources for this page

Verify at the official NPI Registry.