Amy L Tatham, PMHNP, BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ00969700 Issued in NJ

Practice address

525 Route 73 North Ste 104
Marlton, NJ 08053-3008

Phone

(484) 229-4545

Fax

(630) 882-0553

NPI assigned

Nov 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

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.

• Linq Care Medical Provider, LLC.

  • Adult Mental Health Clinic/Center
  • Marlton, NJ
  • NPI 1427795509
  Medicare reassignment NPD
• Regional Women's Health Group, LLC

  dba Axia Women's Health

  • Obstetrics & Gynecology Physician
  • Voorhees, NJ
  • NPI 1548215536
  Medicare reassignment NPD
• Regional Womens Health Group LLC

  dba Axia Women's Health

  • Obstetrics & Gynecology Physician
  • Phoenixville, PA
  • NPI 1750880118
  NPD
• Psychological Services P.a.

  dba Newark Behavioral Health

  • Psychologist
  • Newark, DE
  • NPI 1932754595
  NPD (past)

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683417600000",
    "number": "1447896725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 PEBBLE LANE",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219013502",
            "telephone_number": "856-287-3847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 NORTH STE 104",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533008",
            "telephone_number": "484-229-4545",
            "fax_number": "630-882-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATHAM",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "PMHNP, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2023-05-07",
        "certification_date": "2023-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "AC002993",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00969700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tao Clinic of Acupuncture
• Tao Integrative Medicine
• Marisa Nicole Tate, OTR/L
• Taylor Wegmann LLC
• Paulette Taylor, M.S.
• William Henry Taylor V, AGACNP-BC
• Ashante Taylorcox, MA-MHC, LAC
• Jose Tello

• Psychiatric/Mental Health Nurse Practitioner in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.