State of Mind Psychiatry, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

STATE OF MIND PSYCHIATRY, LLC

Practice address

4364 Western Center Blvd # 2221
Fort Worth, TX 76137-2043

Phone

(817) 393-2061

NPI assigned

Oct 5, 2022

Last updated

Oct 5, 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

Dr. Amanda Kennedy, DNPNPI 1396460010

Title

Pmhnp

Phone

(817) 393-2061

Specialties & licenses 1

Addresses

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.

• Amanda Dawn Kennedy, DNP, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
  • NPI 1396460010
  NPD Authorized official

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1366167082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4364 WESTERN CENTER BLVD # 2221",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761372043",
            "telephone_number": "817-393-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4364 WESTERN CENTER BLVD # 2221",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761372043",
            "telephone_number": "817-393-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MIND PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "817-393-2061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danette Elaine Starr
• Heather Brooke Starr, PTA
• Jacqueline Elaine Starwalt, CRNA
• J. John Stasikowski, M.D., P.A.
• Gitana Staskus, MD
• State of Texas Veterans Land Board
• Kimberly A Staten, LPC-ASSOCIATE
• Myranda Stauch
• Charity Jolynn Stauter, FNP
• Shaina Stavinoha, CPNP

• Psychiatric/Mental Health Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.