Provider Demographics
NPI:1790556108
Name:MINDFUL MEDICINE LLC
Entity Type:Organization
Organization Name:MINDFUL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-833-8843
Mailing Address - Street 1:7200 W 13TH ST N STE 9
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2968
Mailing Address - Country:US
Mailing Address - Phone:316-833-8843
Mailing Address - Fax:
Practice Address - Street 1:7200 W 13TH ST N STE 9
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2968
Practice Address - Country:US
Practice Address - Phone:316-833-8843
Practice Address - Fax:316-400-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty