Provider Demographics
NPI:1891477501
Name:PROSPERITY MENTAL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PROSPERITY MENTAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STASHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:629-888-4161
Mailing Address - Street 1:5906 CHARLOTTE PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3181
Mailing Address - Country:US
Mailing Address - Phone:615-828-0884
Mailing Address - Fax:
Practice Address - Street 1:5906 CHARLOTTE PIKE STE D
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3181
Practice Address - Country:US
Practice Address - Phone:615-828-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty