{
"Npi": {
"NPI": "1326929902",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLNESS SERENITY PATHWAY NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "245 E MARSHALL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HEMPSTEAD",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11550-7532",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-272-0852",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "245 E MARSHALL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HEMPSTEAD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11550-7532",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-272-0852",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/10/2025",
"LastUpdateDate": "01/15/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOUGLAS",
"AuthorizedOfficialFirstName": "PATRINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PMHNP, FNP",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "516-272-0852",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}