Provider Demographics
NPI:1467044560
Name:INVIGORATING MIND & BODY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:INVIGORATING MIND & BODY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEYSHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP-BC, PMHNP-BC
Authorized Official - Phone:757-775-8837
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD STE 203A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4512
Mailing Address - Country:US
Mailing Address - Phone:757-775-8837
Mailing Address - Fax:949-561-4700
Practice Address - Street 1:610 THIMBLE SHOALS BLVD STE 203A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4512
Practice Address - Country:US
Practice Address - Phone:757-775-8837
Practice Address - Fax:949-561-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty