Healthcare Provider Details

I. General information

NPI: 1043991003
Provider Name (Legal Business Name): AMETHYST PSYCHIATRY AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 JAGER DR NE STE C4
RIO RANCHO NM
87144-5715
US

IV. Provider business mailing address

4405 JAGER DR NE STE C4
RIO RANCHO NM
87144-5715
US

V. Phone/Fax

Practice location:
  • Phone: 513-258-1271
  • Fax:
Mailing address:
  • Phone: 513-258-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BELINDA NKAIME
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP
Phone: 513-258-1271