Integrated Primary Care and Behavioral Health Services

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

196483 Issued in NC

Legal business name

INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES

Practice address

6201 Fairview Rd
Suite 200
Charlotte, NC 28210-3289

Phone

(704) 322-4699

Fax

(704) 992-9546

NPI assigned

Feb 10, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Tawanda Bostic, DNP,PMHNP-BC, FNP-BC

Title

Owner

Phone

(704) 322-4699

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1588055685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 FAIRVIEW RD",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103289",
            "telephone_number": "704-322-4699",
            "fax_number": "704-992-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 FAIRVIEW RD",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103289",
            "telephone_number": "704-322-4699",
            "fax_number": "704-992-9546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "BOSTIC",
        "authorized_official_first_name": "TAWANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-322-4699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP,PMHNP-BC, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "196483",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "196483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; 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.