Provider Demographics
NPI:1104472406
Name:BYRD, JAIMA L (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JAIMA
Middle Name:L
Last Name:BYRD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:JAIMA
Other - Middle Name:L
Other - Last Name:BAGIENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MAIDEN NAME
Mailing Address - Street 1:600 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1255
Mailing Address - Country:US
Mailing Address - Phone:765-278-6387
Mailing Address - Fax:
Practice Address - Street 1:600 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1255
Practice Address - Country:US
Practice Address - Phone:765-278-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154489A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health