Amy Patricia Theall, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2020167949 Issued in OR

Practice address

700 S J St
Lakeview, OR 97630-1623

Phone

(541) 947-2114

NPI assigned

Jan 23, 2019

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

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

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Health DistrictGroup PAC ID 4284629221, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.theall.1@9406.direct.athenahealth.com

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.

• Lake Health District

  • Critical Access Hospital
  • Lakeview, OR
  • NPI 1376698522
  Medicare reassignment Care Compare group NPD
• Lake Health District

  • Counseling Psychologist
  • Lakeview, OR
  • NPI 1821711177
  NPD (past)

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1912461088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S G ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301827",
            "telephone_number": "414-507-6218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S J ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301623",
            "telephone_number": "541-947-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEALL",
        "first_name": "AMY",
        "middle_name": "PATRICIA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "2020167949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Steiger
• Erin Danielle Steward, PA-C
• Stuart Bryan Stewart, PEER SUPPORT SPECIAL
• Amanda Leann Strain
• Carter Taylor, QMHA
• Kylie Thomas, MAED
• Unanimous Chiropractic, PC
• Lindsey Underhill
• Tiffany Marie Vale, QMHA CASE MANAGER
• Andrew Walls, DDS

• Psychiatric/Mental Health Nurse Practitioner in Lakeview, OR
• Providers in Lakeview, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.