MEDICARE: MIDWEST PSYCHIATRIC ASSOCIATES LLC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1629729892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PSYCHIATRIC ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2130 S PIN OAK DR
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3143
Country	:	US
Telephone Number	:	417-343-5692
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 S PIN OAK DR
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3143
Country	:	US
Telephone Number	:	417-343-5692
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JAMES SKINNER
Credential	:	MSN, PMHNP-BC
Telephone Number	:	417-343-5692

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/15/2022

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