Provider Demographics
NPI:1467212969
Name:INNERCLARITY PSYCHIATRY & WELLNESS
Entity Type:Organization
Organization Name:INNERCLARITY PSYCHIATRY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, FNP-C
Authorized Official - Phone:952-222-7782
Mailing Address - Street 1:7738 206TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4709
Mailing Address - Country:US
Mailing Address - Phone:651-468-5973
Mailing Address - Fax:563-220-4832
Practice Address - Street 1:8500 NORMANDALE LAKE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3805
Practice Address - Country:US
Practice Address - Phone:952-222-7782
Practice Address - Fax:563-220-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty