Phillip Casey Dubravcic, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP10899 Issued in AZ

Practice address

906 W University Ave Ste 150
Flagstaff, AZ 86001-2603

Phone

(928) 248-8082

Fax

(855) 930-4003

NPI assigned

Jan 15, 2018

Last updated

Jul 17, 2024By the provider in NPPES

Sex

Male

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 AZ

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

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.

• Revitalize Ketamine Clinic LLC

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1346911195
  Medicare reassignment NPD
• Synaptic Psychiatry LLC

  dba Revitalize and Optimize Clinic

  • Psychiatry Physician
  • Flagstaff, AZ
  • NPI 1831946656
  NPD Authorized official

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1962910760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 W UNIVERSITY AVE STE 150",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860012603",
            "telephone_number": "928-248-8082",
            "fax_number": "855-930-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 W UNIVERSITY AVE STE 150",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860012603",
            "telephone_number": "928-248-8082",
            "fax_number": "855-930-4003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3173 N Windsong Dr",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863142240",
            "country_code": "US",
            "telephone_number": "928-493-8222",
            "fax_number": "855-930-4003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1785 W State Route 89A Ste 2B",
            "address_purpose": "LOCATION",
            "city": "Sedona",
            "state": "AZ",
            "postal_code": "863365576",
            "country_code": "US",
            "telephone_number": "928-248-8082",
            "fax_number": "855-930-4003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 S Milton Rd Ste 26",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860016340",
            "country_code": "US",
            "telephone_number": "928-248-8082",
            "fax_number": "855-930-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUBRAVCIC",
        "first_name": "PHILLIP",
        "middle_name": "CASEY",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-15",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP10899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Amelia Drum, RN, FNP-C
• Michael James Druschel, MD
• Amy Klein Duane, LCSW
• David G Dubner, PSYCHOLOGIST, PHD
• Jill Michelle Dubravcic, FNP
• Debbo Duclos, RN
• Madison Dugan
• Mikyla Belle Dugi
• Cassadi Duncan
• Codi Dunlap, RN

• Psychiatric/Mental Health Nurse Practitioner in Flagstaff, AZ
• Providers in Flagstaff, 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 Jul 17, 2024; 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.