Provider Demographics
NPI:1265205553
Name:PEACE OF MIND PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:PEACE OF MIND PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NETHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-248-6415
Mailing Address - Street 1:4405 TWILLINGATE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1400
Mailing Address - Country:US
Mailing Address - Phone:502-548-9100
Mailing Address - Fax:
Practice Address - Street 1:110 S SHERRIN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3222
Practice Address - Country:US
Practice Address - Phone:502-548-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner