Amity Mental Wellness LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Salem, OR
NPI 1417736620 · NPPES record last updated Sep 26, 2023
Key facts
- NPI
- 1417736620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- AMITY MENTAL WELLNESS LLC
- Practice address
- 147 Commercial St NE Ste 7
Salem, OR 97301-3418 - Phone
- (813) 458-7232
- NPI assigned
- Sep 26, 2023
- Organization subpart
- No
Authorized official
- Name
- Lauri Cody
- Title
- Owner of Entity
- Phone
- (813) 458-7232
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250403000807 | DC | Part B Supplier - Clinic/Group Practice | 8527581214 |
Receives reassigned benefits from 1 practitioner Practice locations: Upper Marlboro, MD |
National Provider Directory
Locations
147 Commercial St NE
Ste 7
Salem, OR 97301
Phone (813) 458-7232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
147 Commercial St NE Ste 7
Salem, OR 97301-3418
Mailing address
147 Commercial St NE Ste 7
Salem, OR 97301-3418
Phone (813) 458-7232
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All providers in Salem, OR · Psychiatric/Mental Health Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.