Healthcare Provider Details

I. General information

NPI: 1295352771
Provider Name (Legal Business Name): MINDFUL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 OLD IRONSIDES DR STE 304
SANTA CLARA CA
95054-1846
US

IV. Provider business mailing address

701 MURPHY DR STE 6
MAUMELLE AR
72113-6198
US

V. Phone/Fax

Practice location:
  • Phone: 501-271-9428
  • Fax:
Mailing address:
  • Phone: 501-271-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICA N TAYLOR
Title or Position: OWNER
Credential:
Phone: 501-271-9428