Susan Kelly Niebaum, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

12585557-4405 Issued in UT

Practice address

408 E Kelsey View LN
South Salt Lake, UT 84115-4979

Phone

(406) 212-2177

NPI assigned

Jul 27, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Karen W. Malm, PH.D., P.C.

  • Psychologist
  • Park City, UT
  • NPI 1871701656
  NPD

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

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1861165839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E KELSEY VIEW LN",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841154979",
            "telephone_number": "406-212-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E KELSEY VIEW LN",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841154979",
            "telephone_number": "406-212-2177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEBAUM",
        "first_name": "SUSAN",
        "middle_name": "KELLY",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-27",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "UT",
            "license": "12585557-4405",
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "MT",
            "license": "16869",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Pocatello",
            "affiliation": "N",
            "endpointDescription": "Doximetry",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Pocatello",
            "address_1": "408 E Kelsey View Ln",
            "city": "South Salt Lake",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841154979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Elizabeth Nelson, BSN, RN
• Reem Heaven Nev Bahar, PA
• Nextstep Support Services
• Katie Nicholls, PA-C
• George (Trey) Tanner Nicholson III
• Christine Nielsen, CSW
• Shannon Robinson Nielson, LCSW
• Norco, Inc.
• Jeff Numbers
• Marci Numbers, RN

• Psychiatric/Mental Health Nurse Practitioner in South Salt Lake, UT
• Providers in South Salt Lake, UT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.