Provider Demographics
NPI:1639822828
Name:KNEW MINDSET LLC
Entity Type:Organization
Organization Name:KNEW MINDSET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JALEESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:870-559-9144
Mailing Address - Street 1:PO BOX 1530
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1539
Mailing Address - Country:US
Mailing Address - Phone:870-559-9144
Mailing Address - Fax:
Practice Address - Street 1:944 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9004
Practice Address - Country:US
Practice Address - Phone:870-821-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health