Individual provider Active NPI

Jennifer S Tucker-Mitchell, MSN, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • West Hartford, CT
National Provider Identifier
1336825611
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12011 Issued in CT
Practice address
1 Abrahms Blvd
West Hartford, CT 06117-1508
Phone
(860) 523-3800
NPI assigned
Jun 22, 2023
Last updated
Oct 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 12011 CT Primary

Addresses

Primary practice location

1 Abrahms Blvd
West Hartford, CT 06117-1508

Mailing address

1 Abrahms Blvd
West Hartford, CT 06117-1508
Phone (860) 523-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20231110000449 CT Practitioner - Nurse Practitioner 6204283351 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Connecticut Mental Health Specialists IncGroup PAC ID 0345130563, 65 clinicians
Value Based Long Term Care K PCGroup PAC ID 1355881418, 61 clinicians

Practice addresses (Care Compare)

270 Farmington Ave
Suite 309
Farmington, CT 06032-1953
Phone (860) 677-5570

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12011CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Mental Health Specialists Inc Psychiatric/Mental Health CurrentSince Oct 2, 2023 Accepting new patients
Prohealth Physicians PC PastSince Nov 30, 2023 Accepting new patients

Locations

270 Farmington Ave
Ste 309
Farmington, CT 06032
Phone (860) 677-5570

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1336825611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ABRAHMS BLVD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061171508",
            "telephone_number": "860-523-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ABRAHMS BLVD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061171508",
            "telephone_number": "860-523-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER-MITCHELL",
        "first_name": "JENNIFER",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "MSN, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.