Provider Demographics
NPI:1629729892
Name:MIDWEST PSYCHIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:MIDWEST PSYCHIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:417-343-5692
Mailing Address - Street 1:2130 S PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3143
Mailing Address - Country:US
Mailing Address - Phone:417-343-5692
Mailing Address - Fax:
Practice Address - Street 1:2130 S PIN OAK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-3143
Practice Address - Country:US
Practice Address - Phone:417-343-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty