Basic Information
| Provider Information | |||||||||
| NPI: | 1982248654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NYE-JAIMES | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | NICHOLAS | ||||||||
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| Credential: | RN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 627 NE EVANS ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971283923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034347523 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 627 NE EVANS ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971283923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719012712 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2019 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201909164RN | OR | N | Nursing Service Providers | Registered Nurse | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 363LP0808X | 202213922NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.