=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427846591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCEY HEALTH NURSE PRACTITIONER IN PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 ASTOR AVE FL 2
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10469-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-637-2940
-----------------------------------------------------
Fax | 866-637-2940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 ASTOR AVE FL 2
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10469-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/OWNER
-----------------------------------------------------
Name | DR. DEXTER DEWAYNE WILLIAMS
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 915-740-2780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------