Tyler Weber, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Phoenix, AZ
NPI 1457056582 · NPPES record last updated Mar 30, 2023
Key facts
- NPI
- 1457056582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 289899 (AZ)
- Practice address
- 2373 W Shackleton Dr
Phoenix, AZ 85086-2345 - Phone
- (623) 695-9641
- NPI assigned
- Mar 30, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mind 247 Practice LLC
Practice addresses (Care Compare)
10046 N Metro Pkwy W
Phoenix, AZ 85051-1437
Phone (844) 646-3247
1138 S Higley Rd
Mesa, AZ 85206-3000
Phone (844) 646-3247
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230427003008 | AZ | Practitioner - Nurse Practitioner | 3072978964 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 289899 | AZ | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mind 247 Practice LLC | Current | Accepting new patients | |
| Ironmind Mental Health LLC | Current | Accepting new patients | |
| Mind 247 Practice LLC | Current |
Accepting new patients | |
| Mind 247 Practice LLC | Current |
Accepting new patients | |
| Desert Bolt Behavioral LLC | Psychiatric/Mental Health | Past |
Accepting new patients |
Locations
1220 S Higley Rd
Ste 201
Mesa, AZ 85206
Phone (480) 529-7125
1138 S Higley Rd
Mesa, AZ 85206
Phone (480) 325-3876
10046 N Metro Pkwy W
Phoenix, AZ 85051
Phone (602) 894-2880
10046 N Metro Pkwy W
Ste 115
Phoenix, AZ 85051
Phone (602) 674-5515
1465 N Scottsdale Rd
Ste 400
Scottsdale, AZ 85257
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 289899 | AZ | Yes |
Addresses
Primary practice location
2373 W Shackleton Dr
Phoenix, AZ 85086-2345
Mailing address
2373 W Shackleton Dr
Phoenix, AZ 85086-2345
Phone (623) 695-9641
Other providers in Phoenix, AZ
- Kelly Weber
- Rachel Weber
- Stephanie Christian Weber
- Tiffany J Weber
- Tracy Weber
- Webster Family Chiropractic, LTD.
- Brandon Webster
- Joseph Anthony Webster Jr.
- Kelsey Webster
- Lynda Webster
All providers in Phoenix, AZ · Psychiatric/Mental Health Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.