MINDSET HEALTHCARE PC NPI 1285119925

NPI Information

NPI: 1285119925
Provider Name: MINDSET HEALTHCARE, PC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

CLIA Number: 11D2178572

Address:
135 BRADFORD SQ STE B
FAYETTEVILLE, GA
ZIP 30215
Phone: (470) 646-3738
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MINDSET HEALTHCARE, PC is a psychiatric/mental health nurse practitioner in Fayetteville, GA. MINDSET HEALTHCARE, PC NPI is 1285119925. The provider is registered as an organization entity type.

The provider's business location address is:

135 BRADFORD SQ STE B
FAYETTEVILLE, GA
ZIP 30215-902
Phone: (470) 646-3738
Fax: (888) 910-6463

The provider's authorized official is Omolola A Otubaga .
The authorized official title is Aprn-bc/nurse Practioner and has the following contact phone number (404) 444-1904.

The CLIA number assigned to this NPI record is 11D2178572 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2018 and was last updated on 4/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
3	291U00000X	Clinical Medical Laboratory		No
4	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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