Kemisola Lynda Ebietomiye

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

405625 Issued in NY

Practice address

274 Madison Ave RM 1501
New York, NY 10016-0701

Phone

(212) 203-1773

Fax

(646) 665-4427

NPI assigned

Jan 11, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ, TX, WA, IL, AZ, NM, CT, MA9 enrollments

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 9

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rivia Medical PLLCGroup PAC ID 4880009943, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Rivia Medical PLLC

  dba Rivia Medical

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
  • NPI 1134644032

  NJ

  Medicare reassignment Care Compare group NPD
• Ruby Reflections Mental Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Haslet, TX
  • NPI 1356182380
  Medicare reassignment NPD Authorized official
• Grow Healthcare Group of New Jersey PC

  • Mental Health Counselor
  • Hoboken, NJ
  • NPI 1841949328

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  AZ, CT, IL, MA, NM, NY, Psychiatric/Mental Health, TX, WA

  Medicare reassignment NPD
• Rivia Medical PLLC

  dba RIVIA Mind

  • Nutritionist
  • New York, NY
  • NPI 1871280818
  NPD

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1255102976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 WESTWOOD WAY DR",
            "city": "HASLET",
            "state": "TX",
            "postal_code": "760523079",
            "telephone_number": "469-250-1544",
            "fax_number": "469-242-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 MADISON AVE RM 1501",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100160701",
            "telephone_number": "212-203-1773",
            "fax_number": "646-665-4427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 University Plz Ste 100",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076016210",
            "country_code": "US",
            "telephone_number": "212-203-1773",
            "fax_number": "646-665-4427",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761042733",
            "country_code": "US",
            "telephone_number": "773-621-8983",
            "fax_number": "469-242-9827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBIETOMIYE",
        "first_name": "KEMISOLA",
        "middle_name": "LYNDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-11",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1149539",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ15047800",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabina Eberle
• Sharon Eberstein, M.D.
• Kerry A Ebert, OTR/L, CHT
• Patricia Ann Ebert
• Omonyemen Irenosen Ebhomielen
• Rei Matsuba Ebihara
• Wataru Ebina, MD, PHD
• Ebl Coaching
• Sabrina Shoshana Ebner, M.S. CF-SLP
• Yaniv Ebner, M.D.

• Psychiatric/Mental Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.