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General NPI Number Information
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NPI Number | 1346118106
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Entity Type | Organization
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Legal Business Name | DIVINE PSYCHIATRY LLC
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 678-837-6104
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED INDIVIDUAL
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Name | ANDREW PIERCE
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Credential |
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Telephone | 307-683-0983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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