Mindbridge Psychiatry

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MINDBRIDGE PSYCHIATRY

Practice address

4624 Riddle Dr
Baltimore, MD 21236-5703

Phone

(443) 930-0785

NPI assigned

Jan 14, 2025

Last updated

Jan 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dave Emlyn Thatcher Jr.

Title

Owner

Phone

(443) 930-0785

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1154132876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 RIDDLE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365703",
            "telephone_number": "443-930-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 RIDDLE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365703",
            "telephone_number": "443-930-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBRIDGE PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "THATCHER",
        "authorized_official_first_name": "DAVE",
        "authorized_official_middle_name": "EMLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-930-0785",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.