Justin Robert Wirth, DNP, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

7559 Issued in MN

Practice address

4801 Veterans Dr # 111
Saint Cloud, MN 56303-2015

Phone

(320) 252-1670

NPI assigned

Jul 30, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Justin Robert Wirth Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1629687124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15953 47TH ST NW",
            "city": "ANNANDALE",
            "state": "MN",
            "postal_code": "553023902",
            "telephone_number": "320-290-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 VETERANS DR # 111",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032015",
            "telephone_number": "320-252-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTH",
        "first_name": "JUSTIN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTIN",
            "last_name": "WIRTH",
            "middle_name": "ROBERT",
            "prefix": "DR.",
            "credential": "DNP, APRN, PMHNP-BC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Emmarae Lynn Winter
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• Kelli Marie Winzenburg
• Gina Marie Wippler, PA-C
• Wanda Wirth
• Julie Wiseman, RPH
• Jay Philip Wistrom, LADC
• Hannah Elise Witherspoon, RD, LD
• Mia Jo Wittenberg

• Psychiatric/Mental Health Nurse Practitioner in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.