MEDICARE: BODY & MIND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1336861335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY & MIND WELLNESS

Provider Business Mailing Address
First Line	:	7001 SAINT ANDREWS RD STE 307
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-629-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 SAINT ANDREWS RD STE 307
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1137
Country	:	US
Telephone Number	:	803-629-1209
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTY L THOMPSON
Credential	:	NP
Telephone Number	:	803-629-1209

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	10/21/2025

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Directions to “BODY & MIND WELLNESS ” Practice Location

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