Provider Demographics
NPI:1275147910
Name:AMAZON PSYCHIATRY
Entity Type:Organization
Organization Name:AMAZON PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:KIPKEMOI
Authorized Official - Last Name:DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-627-6174
Mailing Address - Street 1:1185 W MOUNTAIN VIEW RD APT 3401
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2545
Mailing Address - Country:US
Mailing Address - Phone:515-381-6870
Mailing Address - Fax:
Practice Address - Street 1:699 WALNUT ST STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3962
Practice Address - Country:US
Practice Address - Phone:515-381-6870
Practice Address - Fax:800-566-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty