Organization Active NPI

Aj Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Richardson, TX
National Provider Identifier
1639778947
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
AJ PSYCHIATRY PLLC
Practice address
1920 N Coit Rd Ste 219
Richardson, TX 75080-2832
Phone
(214) 744-5438
NPI assigned
Oct 19, 2020
Last updated
Oct 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Authorized official

Name
Judith W Olepere, MSN, PMHNP-BCNPI 1497213094
Title
Owner of Entity
Phone
(214) 744-5438

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

1920 N Coit Rd Ste 219
Richardson, TX 75080-2832

Mailing address

650 Bonham Dr
Lavon, TX 75166-1763
Phone (214) 744-5438

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201102000626 TX Part B Supplier - Clinic/Group Practice 7911317052 Receives reassigned benefits from 1 practitioner
Practice locations: Wylie, TX

National Provider Directory

National Provider Directory

Locations

1920 N Coit Rd
Ste 219
Richardson, TX 75080
Phone (214) 744-5438

101 S Jackson Ave
Ste 300
Wylie, TX 75098
Phone (214) 629-5829

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1639778947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 BONHAM DR",
            "city": "LAVON",
            "state": "TX",
            "postal_code": "751661763",
            "telephone_number": "214-744-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 N COIT RD STE 219",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750802832",
            "telephone_number": "214-744-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "OLEPERE",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER OF ENTITY",
        "authorized_official_telephone_number": "214-744-5438",
        "authorized_official_credential": "MSN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.