Blue River Psychiatry NP PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

BLUE RIVER PSYCHIATRY NP PLLC

Practice address

369 Washington Ave
Kingston, NY 12401-3701

Phone

(914) 401-0008

Fax

(914) 401-0009

NPI assigned

Feb 24, 2022

Last updated

Mar 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mina JohnsonNPI 1285154583

Title

Practitioner

Phone

(914) 401-0008

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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.

• Mina Johnson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
  • NPI 1285154583
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1710633185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 WASHINGTON AVE STE 1A",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013701",
            "telephone_number": "914-401-0008",
            "fax_number": "914-401-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 WASHINGTON AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013701",
            "telephone_number": "914-401-0008",
            "fax_number": "914-401-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIVER PSYCHIATRY NP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MINA",
        "authorized_official_title_or_position": "PRACTITIONER",
        "authorized_official_telephone_number": "914-401-0008"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert John Blair III, M.D.
• Michael Paul Blankschen, PHD
• Dean Bloch, MD
• Deena Bloom, LCSW
• Marsha Bloom
• Sydney L. Blum, LCSW CASAC SAP
• Marcia S Bockelmann, PT ASST
• Sara Bockelmann
• Emily Marie Bodin
• Elizabeth Bodisch, LPN

• Psychiatric/Mental Health Nurse Practitioner in Kingston, NY
• Providers in Kingston, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.