Provider Demographics
NPI:1598465551
Name:BRIGHT SOUL WELLNESS CENTER
Entity Type:Organization
Organization Name:BRIGHT SOUL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:812-878-8223
Mailing Address - Street 1:2186 W US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7201
Mailing Address - Country:US
Mailing Address - Phone:812-878-8223
Mailing Address - Fax:
Practice Address - Street 1:2186 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-7201
Practice Address - Country:US
Practice Address - Phone:812-878-8223
Practice Address - Fax:812-443-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care