Healthcare Provider Details

I. General information

NPI: 1285453035
Provider Name (Legal Business Name): PATRICIA CODY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 84 1632 SINGLEY LANE
UPPER BLACK EDDY PA
18972
US

IV. Provider business mailing address

PO BOX 84 1632 SINGLEY LANE
UPPER BLACK EDDY PA
18972
US

V. Phone/Fax

Practice location:
  • Phone: 215-534-3723
  • Fax: 551-361-9199
Mailing address:
  • Phone: 215-534-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15150100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: