Healthcare Provider Details

I. General information

NPI: 1639822828
Provider Name (Legal Business Name): KNEW MINDSET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 02/24/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 STATE HIGHWAY 77
MARION AR
72364-9004
US

IV. Provider business mailing address

PO BOX 1530
MARION AR
72364-1539
US

V. Phone/Fax

Practice location:
  • Phone: 870-821-0315
  • Fax:
Mailing address:
  • Phone: 870-559-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JALEESA SHEARS
Title or Position: OWNER
Credential: DNP, APRN
Phone: 870-559-9144