Jamie Lynn Gustafson, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

268837 Issued in AZ

Practice address

312 N Alma School Rd
Chandler, AZ 85224-4354

Phone

(602) 762-8142

NPI assigned

Jan 18, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Az Holistic Anxiety Treatment, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1942013420
  NPD Authorized official
• Adelante Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mesa, AZ
  • NPI 1891853446
  NPD (past)

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

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1780335109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 N ALMA SCHOOL RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N ALMA SCHOOL RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244354",
            "telephone_number": "602-762-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "268837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shradha Gupta, M.D.
• Suprit Gupta, LAMFT
• Leslie Dawn Gurtler, RN
• Charlotte V Gurule, M.D.
• Megan Nicole Guse, PA-C
• Carol E Gutierrez, NP-C
• Helen Domingo Gutierrez
• Janel R. Gutierrez, FNP-C
• Monica Marie Gutierrez, LCSW
• Jennifer M Guy-Carchidi, PT, DPT

• Psychiatric/Mental Health Nurse Practitioner in Chandler, AZ
• Providers in Chandler, 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 Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.