Indiana Telepsych NP, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

INDIANA TELEPSYCH NP, LLC

Practice address

1246 E Marigold Dr
Bloomington, IN 47401-8983

Phone

(812) 599-4138

NPI assigned

Feb 19, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Amanda Kent, PMHNP-BCNPI 1568138444

Title

Owner

Phone

(812) 599-4138

Specialties & licenses 1

Addresses

Other names 1

• Indiana TelePsych NP, LLC Doing business as

Practitioners 1

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

• Amanda V Kent

  • Psychiatric/Mental Health Nurse Practitioner
  • Bloomington, IN
  • NPI 1568138444
  NPD Authorized official

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1528823697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 E MARIGOLD DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018983",
            "telephone_number": "812-599-4138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 E MARIGOLD DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474018983",
            "telephone_number": "812-599-4138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA TELEPSYCH NP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-18",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-599-4138",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana TelePsych NP, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Bloomington, IN
• Adult Mental Health Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.