Provider Demographics
NPI:1689436859
Name:IVY ADVANCED PRACTICE HEALTH, PLLC
Entity Type:Organization
Organization Name:IVY ADVANCED PRACTICE HEALTH, PLLC
Other - Org Name:MIND FIT BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:704-978-8334
Mailing Address - Street 1:103 BILLINSGATE CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6702
Mailing Address - Country:US
Mailing Address - Phone:704-978-8334
Mailing Address - Fax:980-399-2600
Practice Address - Street 1:103 BILLINSGATE CT
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6702
Practice Address - Country:US
Practice Address - Phone:704-978-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVY ADVANCED PRACTICE HEALTH, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty