Modern Integrative Psychiatry, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MODERN INTEGRATIVE PSYCHIATRY, LLC

Practice address

13000 Rivers Bend Blvd
Chester, VA 23836-8632

Phone

(804) 234-4893

NPI assigned

Aug 22, 2023

Organization subpart

No

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

Authorized official

Name

Petitecha Wimbush, PMHNP-BCNPI 1285207522

Title

Psychiatric Nurse Practitioner/Ceo

Phone

(804) 234-4893

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Petitecha Wimbush, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chester, VA
  • NPI 1285207522
  NPD Authorized official

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1972387892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368632",
            "telephone_number": "804-234-4893",
            "fax_number": "804-964-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368632",
            "telephone_number": "804-234-4893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN INTEGRATIVE PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-22",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "WIMBUSH",
        "authorized_official_first_name": "PETITECHA",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER/CEO",
        "authorized_official_telephone_number": "804-234-4893",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Jensen Miller, MSW
• Tayedia Shanice Miller
• Anthony Junius Mills, MS
• Mitchell Sports Performance
• Angela Dise Mitchell, PHARM.D
• Lauren Montgomery, OTD/OTR/L
• Tracy Louise Moore Duarte, MSN, PMHNP-BC
• Morris Cardiovascular and Risk Reduction Center PC
• Clifford Vincent Morris, MD
• Corrinthia Morris

• Psychiatric/Mental Health Nurse Practitioner in Chester, VA
• Providers in Chester, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.