Individual provider Active NPI

Brandon Webster, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1164067922
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP-263878 Issued in AZ
Practice address
750 E Thunderbird Rd Ste 1
Phoenix, AZ 85022-5306
Phone
(602) 230-7373
Fax
(602) 218-6383
NPI assigned
Nov 15, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X RN205161 AZ
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NONE AZ
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP-263878 AZ Primary

Addresses

Primary practice location

750 E Thunderbird Rd Ste 1
Phoenix, AZ 85022-5306

Mailing address

3101 N Central Ave Ste 550
Phoenix, AZ 85012-2635
Phone (602) 473-2928

Other practice location 1

17806 N 13th Pl
Phoenix, AZ 85022-1202
Phone (412) 609-7862

Other practice location 2

610 E Baseline Rd Ste 5
Phoenix, AZ 85042-6536
Phone (602) 230-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20211130001451 AZ Practitioner - Nurse Practitioner 2466842737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Denova Collaborative Health, LLC 141 clinicians

Practice addresses (Care Compare)

3033 N Central Ave
Suite 700
Phoenix, AZ 85012-2806
Phone (602) 230-7373

750 E Thunderbird Rd
1 3
Phoenix, AZ 85022-5306
Phone (602) 230-7373

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NONEAZMDDentist
AP-263878AZMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Denova Collaborative Health, LLC CurrentSince Jan 11, 2022 Accepting new patients
Denova Collaborative Health, LLC CurrentSince Jan 11, 2022 Accepting new patients
Denova Collaborative Health, LLC Current Accepting new patients
Denova Collaborative Health, LLC Past Accepting new patients

Locations

235 W Western Ave
Avondale, AZ 85323
Phone (623) 772-5091

750 E Thunderbird Rd
Ste 13
Phoenix, AZ 85022
Phone (602) 682-7455

3033 N Central Ave
Ste 700
Phoenix, AZ 85012
Phone (602) 281-7289

3620 N 3rd St
Phoenix, AZ 85012
Phone (602) 329-8250

3101 N Central Ave
Ste 500
Phoenix, AZ 85012

3101 N Central Ave
Ste 550
Phoenix, AZ 85012

610 E Baseline Rd
Ste 5
Phoenix, AZ 85042

Interoperability endpoints

  • Direct secure messaging: denova.brandonwebster@141317.advancedmd-direct.com

Organizations & group practices 4

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": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1164067922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE STE 550",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122635",
            "telephone_number": "602-473-2928",
            "fax_number": "602-682-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E THUNDERBIRD RD STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850225306",
            "telephone_number": "602-230-7373",
            "fax_number": "602-218-6383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17806 N 13th Pl",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850221202",
            "country_code": "US",
            "telephone_number": "412-609-7862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 E Baseline Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850426536",
            "country_code": "US",
            "telephone_number": "602-230-7373",
            "fax_number": "602-441-5836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEBSTER",
        "first_name": "BRANDON",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-15",
        "last_updated": "2023-12-08",
        "certification_date": "2021-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RN205161",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "NONE",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP-263878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.