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General NPI Number Information
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NPI Number | 1467212969
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Entity Type | Organization
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Legal Business Name | INNERCLARITY PSYCHIATRY & WELLNESS
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 8500 NORMANDALE LAKE BLVD STE 350
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City | BLOOMINGTON
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State | MN
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Zip | 55437-3805
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Country | US
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Telephone | 952-222-7782
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Fax | 563-220-4832
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Provider Business Mailing Address
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Address Line | 7738 206TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-4709
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Country | US
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Telephone | 651-468-5973
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Fax | 563-220-4832
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AICHA KATTY
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Credential | DNP, PMHNP-BC, FNP-C
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Telephone | 952-222-7782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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