Provider Demographics
NPI:1043991003
Name:AMETHYST PSYCHIATRY AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:AMETHYST PSYCHIATRY AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKAIME
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:513-258-1271
Mailing Address - Street 1:4405 JAGER DR NE STE C4
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5715
Mailing Address - Country:US
Mailing Address - Phone:513-258-1271
Mailing Address - Fax:
Practice Address - Street 1:4405 JAGER DR NE STE C4
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5715
Practice Address - Country:US
Practice Address - Phone:513-258-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty