Provider Demographics
NPI:1962650705
Name:EAGLES NEST HOLISTIC MENTAL HEALTH INC
Entity Type:Organization
Organization Name:EAGLES NEST HOLISTIC MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:913-530-2802
Mailing Address - Street 1:32800 W 91ST TERRACE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018
Mailing Address - Country:US
Mailing Address - Phone:913-530-2802
Mailing Address - Fax:913-585-1157
Practice Address - Street 1:719 1/2 MASS. SUITE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:913-530-2802
Practice Address - Fax:913-530-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-58010-092163WP0809X
KS14-58010-092RN363LP0808X
KS74085APNR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty