MEDICARE: MR. BRENT SKALL APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0034479	OH

General Provider Information

NPI Number	:	1275215667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT SKALL APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	14723 DELAWARE AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-5942
Country	:	US
Telephone Number	:	330-608-4894
Fax Number	:

Provider Business Practice Location Address
First Line	:	3094 W MARKET ST STE 203
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3624
Country	:	US
Telephone Number	:	740-326-6069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	01/28/2026

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