MAGNOLIA PSYCHIATRY
NPI 1255090510
Nurse Practitioner - Psychiatric/Mental Health in Louisville, KY
About Magnolia Psychiatry NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MAGNOLIA PSYCHIATRY (NPI 1255090510) is a healthcare organization registered as a psychiatric/mental health in Louisville, Kentucky and active in the NPI registry since December 2021. The organization maintains a secondary practice location in Bowling Green and lists Angel Squire, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Magnolia Psychiatry is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Magnolia Psychiatry, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Magnolia Psychiatry's NPI number?
The NPI number for Magnolia Psychiatry is 1255090510. It was assigned to this organization in the NPPES registry on December 14, 2021.
Where is Magnolia Psychiatry located?
Magnolia Psychiatry is located at 312 S 4th St Ste 700, Louisville, KY 40202. The listed phone number is (615) 813-0726.
What is Magnolia Psychiatry's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Magnolia Psychiatry enrolled in Medicare?
Yes. Magnolia Psychiatry is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Magnolia Psychiatry?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Magnolia Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Magnolia Psychiatry was last updated on February 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Magnolia Psychiatry · NPI 1255090510
Psychiatric/Mental Health organization in Louisville, Kentucky. Organization record, active in the CMS NPPES registry since December 14, 2021.
## Identity
- **NPI:** 1255090510 (Entity type: Organization)
- **Enumerated:** December 14, 2021
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Angel Squire, OWNER
## Practice location
- **Address:** 312 S 4TH ST STE 700, Louisville, KY 40202-3046
- **Phone:** (615) 813-0726
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 3, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1255090510) · Data from the CMS NPPES public registry.