=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932062247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX NP IN PSYCHIATRY AND NP IN ADULT HEALTH SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12630 146TH ST
-----------------------------------------------------
City | SOUTH OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11436-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-731-1563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12630 146TH ST
-----------------------------------------------------
City | SOUTH OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11436-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-731-1563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BERNADETTE L MAYERS
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 347-731-1563
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------