Blue Water Psychiatry

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BLUE WATER PSYCHIATRY

Practice address

2491 E Boston St
Gilbert, AZ 85295-2379

Phone

(602) 872-8243

Fax

(480) 631-0546

NPI assigned

Jul 28, 2021

Organization subpart

No

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

Authorized official

Name

Justin McKinley, PMHNP-BCNPI 1053907840

Title

Nurse Practitioner

Phone

(602) 872-8243

Specialties & licenses 1

Addresses

Practitioners 1

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

• Justin McKinley, PMHNP

  • Psychiatry Physician
  • Gilbert, AZ
  • NPI 1053907840

  Psychiatric/Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1699448316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2491 E BOSTON ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852952379",
            "telephone_number": "602-872-8243",
            "fax_number": "480-631-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2491 E BOSTON ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852952379",
            "telephone_number": "602-872-8243",
            "fax_number": "480-631-0546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "MCKINLEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "602-872-8243",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.