Magnolia Psychiatry

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MAGNOLIA PSYCHIATRY

Practice address

312 S 4TH St Ste 700
Louisville, KY 40202-3046

Phone

(615) 813-0726

NPI assigned

Dec 14, 2021

Last updated

Feb 3, 2022By 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

Angel Squire, PMHNPNPI 1699309666

Title

Owner

Phone

(615) 813-0726

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angel Sue Squire, APRN - PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bowling Green, KY
  • NPI 1699309666
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1255090510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4523 SHADY PLACE CT",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421044423",
            "telephone_number": "937-285-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 S 4TH ST STE 700",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023046",
            "telephone_number": "615-813-0726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4523 Shady Place Ct",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421044423",
            "country_code": "US",
            "telephone_number": "937-285-0414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGNOLIA PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-14",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "SQUIRE",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-813-0726",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn E Maglinger
• Magna Pharmaceuticals, Inc
• Brittany Shae Magness, LCSW
• Shaina Magness
• Magnolia Dental
• Haaken Reed Magnuson, DMD
• Kimberly Magoon, M.S.
• Leann L. Magre, MSSW, LCSW
• Emily Magrum, PT, DPT
• Kristin Maguino, APRN

• Psychiatric/Mental Health Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.