Provider Demographics
NPI:1023834926
Name:MINDFUL HEALING PSYCHIATRY LLC
Entity type:Organization
Organization Name:MINDFUL HEALING PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:360-888-0449
Mailing Address - Street 1:16520 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8492
Mailing Address - Country:US
Mailing Address - Phone:360-888-0449
Mailing Address - Fax:
Practice Address - Street 1:2176 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9374
Practice Address - Country:US
Practice Address - Phone:208-391-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty