Healthcare Provider Details

I. General information

NPI: 1043159601
Provider Name (Legal Business Name): NAMASTE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD # 4439
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2501 CHATHAM RD # 4439
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 256-468-5436
  • Fax: 256-468-5436
Mailing address:
  • Phone: 256-468-5436
  • Fax: 256-468-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NITA RAUT
Title or Position: NURSE PRACTITIONER
Credential: PMHNP,FNP
Phone: 256-468-5436