Provider Demographics
NPI:1689560500
Name:MINDFUL SHINE, LLC
Entity type:Organization
Organization Name:MINDFUL SHINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JONES-WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-313-9406
Mailing Address - Street 1:4540 LINDELL BLVD APT 106
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2040
Mailing Address - Country:US
Mailing Address - Phone:913-313-9406
Mailing Address - Fax:
Practice Address - Street 1:4049 PENNSYLVANIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3022
Practice Address - Country:US
Practice Address - Phone:913-313-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty