# JR NURSE PRACTITIONER IN PSYCHIATRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558169623
- **Authorized official:** KENNETH EDICK PHD (HEALTHCARE ADMINISTRATOR)
- **Authorized official phone:** (518) 788-7983

## Contact information

- **Practice address:** 430 FRANKLIN ST STE 2304, SCHENECTADY, NY 12305-2018
- **Practice address phone:** (518) 788-7983
- **Practice address fax:** (866) 616-2109
- **Mailing address:** 99 HYDE BLVD, BALLSTON SPA, NY 12020-1607
- **Mailing address phone:** (518) 368-1691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2025
- **Last updated:** 03/05/2025