Provider Demographics
NPI:1679451835
Name:TIREY, MARY GRACE CARAMPATANA (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:CARAMPATANA
Last Name:TIREY
Suffix:
Gender:F
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:
Other - Last Name:TIREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:3781 W ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1920
Mailing Address - Country:US
Mailing Address - Phone:937-476-1940
Mailing Address - Fax:
Practice Address - Street 1:3781 W ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1920
Practice Address - Country:US
Practice Address - Phone:937-476-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0040125363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty