Healthcare Provider Details

I. General information

NPI: 1982248654
Provider Name (Legal Business Name): ANDREW NICHOLAS NYE-JAIMES RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

IV. Provider business mailing address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

V. Phone/Fax

Practice location:
  • Phone: 971-901-2712
  • Fax:
Mailing address:
  • Phone: 503-434-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201909164RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202213922NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: