MEDICARE: MINDPLEXITY PSYCHIATRIC SERVICES, PLLC

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

General Provider Information

NPI Number	:	1437808433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDPLEXITY PSYCHIATRIC SERVICES, PLLC

Provider Business Mailing Address
First Line	:	555 S PERRYVILLE RD STE 130
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2527
Country	:	US
Telephone Number	:	815-995-2201
Fax Number	:	224-999-4002

Provider Business Practice Location Address
First Line	:	555 S PERRYVILLE RD STE 130
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2527
Country	:	US
Telephone Number	:	815-995-2201
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JENNIE KRULL
Credential	:	APRN
Telephone Number	:	224-465-4309

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	06/01/2026

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