Healthcare Provider Details

I. General information

NPI: 1497609879
Provider Name (Legal Business Name): MATTHEW TYLER RAMOS APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 HIGHWAY 190
MANDEVILLE LA
70471-3250
US

IV. Provider business mailing address

186 OAKWOOD DR
MANDEVILLE LA
70448-3572
US

V. Phone/Fax

Practice location:
  • Phone: 985-502-3597
  • Fax:
Mailing address:
  • Phone: 985-502-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number215550
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number215550
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: