Pine Run Mental Health & Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PINE RUN MENTAL HEALTH & WELLNESS

Practice address

400 Market St
Williamsport, PA 17701-6344

Phone

(929) 724-2277

Fax

(929) 724-2277

NPI assigned

Sep 30, 2024

Organization subpart

No

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

Authorized official

Name

David Christopher Petersen, NPNPI 1225497894

Title

Pmhnp/Owner

Phone

(570) 215-9965

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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.

• David Petersen, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Brooklyn, NY
  • NPI 1225497894

  PA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783296000000",
    "number": "1902624869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 PINE RUN RD",
            "city": "LINDEN",
            "state": "PA",
            "postal_code": "177448149",
            "telephone_number": "570-215-9965",
            "fax_number": "570-215-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MARKET ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016344",
            "telephone_number": "929-724-2277",
            "fax_number": "929-724-2277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2319 Pine Run Rd",
            "address_purpose": "LOCATION",
            "city": "Linden",
            "state": "PA",
            "postal_code": "177448149",
            "country_code": "US",
            "telephone_number": "929-724-2277",
            "fax_number": "929-724-2277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE RUN MENTAL HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-30",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PMHNP/OWNER",
        "authorized_official_telephone_number": "570-215-9965",
        "authorized_official_credential": "NP"
    },
    "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": []
}

• Pharmacpo 2 Inc
• Curtis Paul Phibbs, O.D., M.S.
• Phoenix Rehabilitation and Health Services, Inc.
• Thomas Robert Piccirilli, OD
• Steven Brooks Daniels Pinckney, DO
• Katrin Hunt Pinkham
• Ivan Pinsky, CRNA
• William Gilbert Piotrowski, DC
• Kimberly Pish, DO
• Charlene Angella Pitter

• Psychiatric/Mental Health Nurse Practitioner in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2026; 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.