Provider Demographics
NPI:1245059153
Name:MINDFUL MEDS PSYCHIATRY AND WELLNESS LLC
Entity type:Organization
Organization Name:MINDFUL MEDS PSYCHIATRY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKER-KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:302-330-8633
Mailing Address - Street 1:501 SILVERSIDE RD STE 61
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1394
Mailing Address - Country:US
Mailing Address - Phone:302-330-8633
Mailing Address - Fax:402-246-5653
Practice Address - Street 1:501 SILVERSIDE RD STE 61
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1394
Practice Address - Country:US
Practice Address - Phone:302-330-8633
Practice Address - Fax:402-246-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty