Healthcare Provider Details

I. General information

NPI: 1679451835
Provider Name (Legal Business Name): MARY GRACE CARAMPATANA TIREY APRN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY GRACE TIREY PMHNP-BC

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5386 COX SMITH RD
MASON OH
45040-6803
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0040125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: