Jelya Ingrid Fatawu, PMHMP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2022035166 Issued in MO

Practice address

4 Liberty Grove CT
Wentzville, MO 63385-7188

Phone

(216) 246-5697

Fax

(314) 216-3851

NPI assigned

Nov 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Med Management of Kansas LLC

  • Psychiatry Physician
  • San Antonio, TX
  • NPI 1942800859

  MO

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MO

  Medicare reassignment NPD
• Stability Psychiatry LLC

  • Adult Mental Health Clinic/Center
  • Albuquerque, NM
  • NPI 1457119489
  NPD Authorized official
• Beth Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Frankfort, IL
  • NPI 1063193829
  NPD (past)

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1184331902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 LIBERTY GROVE CT",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633857188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 LIBERTY GROVE CT",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633857188",
            "telephone_number": "216-246-5697",
            "fax_number": "314-216-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATAWU",
        "first_name": "JELYA",
        "middle_name": "INGRID",
        "name_prefix": "Ms.",
        "credential": "PMHMP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-01",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2022035166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Essent Heealthcare of Missouri Inc.
• Alison Nicole Evans, M.S. CCC-SLP
• Candice Justine Exely, DC, CCSP, LAT
• Family 1St Services LLC
• Jarod Bruce Farnham, LPC
• Lindsay Marie Fazio, LCSW, MSW
• Steven Matthew Fine, RPH
• Kailey Finnern
• Kallie Fischer, DC
• Kerry E Florence, MD

• Psychiatric/Mental Health Nurse Practitioner in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.