New Moon Mental Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

NEW MOON MENTAL HEALTH LLC

Practice address

1970 E 17TH St Ste 111B
Idaho Falls, ID 83404-8046

Phone

(208) 541-5257

Fax

(208) 742-2695

NPI assigned

Oct 11, 2023

Organization subpart

No

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

Authorized official

Name

Denise Barnes

Title

Owner

Phone

(208) 716-6445

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Loraine Bird, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1851470785
  Medicare reassignment NPD

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

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1508647983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 E 17TH ST STE 111B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048046",
            "telephone_number": "208-541-5257",
            "fax_number": "208-742-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 E 17TH ST STE 111B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048046",
            "telephone_number": "208-541-5257",
            "fax_number": "208-742-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MOON MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-716-6445"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.