Individual provider Active NPI

Nishaben T. Patel, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1528611365
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN243653 Issued in GA
Practice address
3120 North Oak Street Extension, Suite B
Valdosta, GA 31602
Phone
(229) 671-6164
Fax
(229) 671-6761
NPI assigned
Jul 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN243653 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN243653 GA Primary

Addresses

Primary practice location

3120 North Oak Street Extension, Suite B
Valdosta, GA 31602

Mailing address

3120 North Oak Street Extension, Suite C
Valdosta, GA 31602
Phone (229) 671-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20200107000511 GA Practitioner - Nurse Practitioner 2860826476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Behavioral Health Services of South GeorgiaGroup PAC ID 0840181426, 15 clinicians

Practice addresses (Care Compare)

3120 N Oak St Ext
Suite B
Valdosta, GA 31602-5910
Phone (229) 671-6170

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Services of South Georgia CurrentSince Nov 11, 2019 Accepting new patients
Behavioral Health Crisis Center PastSince Jul 28, 2019 Accepting new patients

Locations

203 Industrial Park Dr
Adel, GA 31620
Phone (229) 896-4559

334 Tifton Eldorado Rd
Tifton, GA 31794
Phone (229) 391-2300

3120 N Oak Street Ext
Ste B
Valdosta, GA 31602
Phone (229) 671-6164

3120 N Oak Street Ext
Ste C
Valdosta, GA 31602
Phone (229) 671-6100

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1528611365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 NORTH OAK STREET EXTENSION, SUITE C",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-671-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 NORTH OAK STREET EXTENSION, SUITE B",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-671-6164",
            "fax_number": "229-671-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "NISHABEN",
        "middle_name": "T.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN243653",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN243653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.