Individual provider Active NPI

Courtney Andrejczak, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1568918050
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP132281 Issued in TX
Practice address
2411 NE Loop 410 Ste 114
San Antonio, TX 78217-6600
Phone
(210) 868-5801
NPI assigned
Aug 25, 2016
Last updated
Sep 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP132281 TX Primary
Registered Nurse 163W00000X 860111 TX

Addresses

Primary practice location

2411 NE Loop 410 Ste 114
San Antonio, TX 78217-6600

Mailing address

12131 Sapphire Riv
San Antonio, TX 78245-4771
Phone (979) 732-7972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20260114002142 TX Practitioner - Nurse Practitioner 3971089400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12131 Sapphire Riv
San Antonio, TX 78245-4771

21111 Amalfi Oaks
San Antonio, TX 78259-1722

2411 NE Loop
410 Suite 114
San Antonio, TX 78217-6600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
860111TXMDRegistered Nurse
AP132281TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Graceland Psychiatric and Neuromodulation Center PLLC CurrentSince Jan 7, 2026 Accepting new patients

Locations

2003 Rogers Rd
Ste 106
San Antonio, TX 78251
Phone (210) 375-5000

2411 NE Loop 410
Ste 114
San Antonio, TX 78217

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1568918050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12131 SAPPHIRE RIV",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782454771",
            "telephone_number": "979-732-7972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 NE LOOP 410 STE 114",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782176600",
            "telephone_number": "210-868-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDREJCZAK",
        "first_name": "COURTNEY",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-25",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP132281",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "860111",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.