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Ahp Psych NP PC

NPI 1649094012ActiveOrganization· Nurse Practitioner, Psych/Mental Health· Mesa, AZ

Nurse Practitioner, Psych/Mental Health in Mesa, Arizona, registered in NPPES in November 2024. The authorized official on file is Kelly Black, PMHNP, Owner/Pmhnp. Enrolled in Medicare as part b supplier - clinic/group practice.

Overview

NPI1649094012
StatusActive
Entity typeOrganization
NPI issuedNov 13, 2024
Last updated in NPPESMar 4, 2025
Certified by providerFeb 21, 2025

Specialties and licenses

TaxonomyCodeLicenseState
Nurse Practitioner, Psych/Mental Health Primary363LP0808X——

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 4, 2026No match—
New York OMIG · Nov 4, 2026No match—
Ohio Medicaid · Nov 4, 2026No match—
Pennsylvania Medicheck · Nov 4, 2026No match—
Washington HCA · Nov 4, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Part B Supplier - Clinic/Group Practice (AZ)

Medicare sources and data years

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