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General NPI Number Information
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NPI Number | 1689555328
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Entity Type | Organization
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Legal Business Name | UPWELL PSYCHIATRY PLLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 10/05/2025
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Provider Practice Location Address
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Address Line | 48 FRONT ST STE 207
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City | BATH
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State | ME
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Zip | 04530-2524
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Country | US
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Telephone | 207-739-4208
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | WISCASSET
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State | ME
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Zip | 04578-0114
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Country | US
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Telephone | 207-739-4208
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | JACLYN BURSKEY
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Credential | PMHNP-BC
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Telephone | 207-739-4208
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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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