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NPI 1114613908ActiveOrganization· Nurse Practitioner, Psych/Mental Health· Charlotte, NC
Nurse Practitioner, Psych/Mental Health in Charlotte, North Carolina, registered in NPPES in April 2023. The authorized official on file is Mary Blake, NURSE PRACTITIONER, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1114613908 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 13, 2023 |
| Last updated in NPPES | Sep 24, 2025 |
| Certified by provider | Sep 24, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Psych/Mental Health Primary | 363LP0808X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NC) |
|---|
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