Provider Demographics
NPI:1043975048
Name:MINDFUL INNOVATIONS
Entity Type:Organization
Organization Name:MINDFUL INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C, PMHNP-BC
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:336-847-1626
Mailing Address - Street 1:1155 DOUBLE POND LN
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9242
Mailing Address - Country:US
Mailing Address - Phone:336-847-1626
Mailing Address - Fax:
Practice Address - Street 1:4154 MENDENHALL OAKS PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8034
Practice Address - Country:US
Practice Address - Phone:336-847-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2023-08-18
Deactivation Date:2023-08-07
Deactivation Code:
Reactivation Date:2023-08-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty