Healthcare Provider Details

I. General information

NPI: 1588893978
Provider Name (Legal Business Name): OZZIE AMENDA HAIRSTON DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 E LIVINGSTON AVE STE E
COLUMBUS OH
43227-1923
US

IV. Provider business mailing address

1121 WORTHINGTON WOODS BLVD # 6160
COLUMBUS OH
43085-1568
US

V. Phone/Fax

Practice location:
  • Phone: 281-406-1112
  • Fax: 713-583-2081
Mailing address:
  • Phone: 281-406-1112
  • Fax: 713-583-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61379474
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5019486
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61379476
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0033460
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1012284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: