Fatima Odetalla, DNP, FNP/PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F401694 Issued in NY

Practice address

65 E Maltbie Ave
Suffern, NY 10901-6007

Phone

(901) 590-7680

NPI assigned

May 16, 2014

Last updated

Nov 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Tennessee, HSC, College of Medicine, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Fatima Odetalla, NP in Psychiatry, PLLC

  dba Lighthouse Behavioral Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Nyack, NY
  • NPI 1639771744

  Family

  NPD Authorized official
• Amber Benson Pmhnp PC

  dba Benson Health Clinic

  • Psychiatric/Mental Health Nurse Practitioner
  • Eugene, OR
  • NPI 1912042862
  Medicare reassignment

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1881005478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 E MALTBIE AVE",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109016007",
            "telephone_number": "901-590-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 E MALTBIE AVE",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109016007",
            "telephone_number": "901-590-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODETALLA",
        "first_name": "FATIMA",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP/PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-16",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338723",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "18374",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "18374",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Jennifer O'Hara, RDH
• Alysa Marie O'Keefe, MA CCC-SLP
• Maria Da Conceicao O'Shea, PT
• David Ober, M.D.
• Chito A Oclarit
• Deniz Oguz, MD
• Haline Marie Ojeda, RN
• Nicholas Joseph Olano, RD, CDN
• Drew Olsen, MD
• Olukitibi Care Medical Practice, PC

• Psychiatric/Mental Health Nurse Practitioner in Suffern, NY
• Providers in Suffern, 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 Nov 17, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.