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NPI Code Detail

MEDICARE: DR. OZZIE AMENDA HAIRSTON DNP, PMHNP-BC

MEDICARE: DR. OZZIE AMENDA HAIRSTON DNP, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN61379474WA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5019486NC
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAP61379476WA
4363LP0808XPsychiatric/Mental Health Nurse Practitioner0033460OH
5363LP0808XPsychiatric/Mental Health Nurse Practitioner1012284TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP61379476OTHERWAAP61379476
20033460OTHEROH0033460
31012284OTHERTXTEXAS STATE 1012284
45019486OTHERNC5019486

General Provider Information

NPI Number : 1588893978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OZZIE AMENDA HAIRSTON DNP, PMHNP-BC
Provider Business Mailing Address
First Line : PO BOX 72198
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-8198
Country : US
Telephone Number : 281-406-1112
Fax Number : 713-583-2081
Provider Business Practice Location Address
First Line : 7385 STATE ROUTE 3 UNIT 460
Second Line :
City : WESTERVILLE
State : OH
Zip : 43082-8654
Country : US
Telephone Number : 281-406-1112
Fax Number : 713-583-2081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2009
Last Update Date : 03/26/2026

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