Healthcare Provider Details

I. General information

NPI: 1124938824
Provider Name (Legal Business Name): WILDFLOWER MIND CO,. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28280 PORTAGE PT STE 102
MILLSBORO DE
19966-4354
US

IV. Provider business mailing address

30921 MANCHESTER LN
LAUREL DE
19956-3587
US

V. Phone/Fax

Practice location:
  • Phone: 302-214-5718
  • Fax:
Mailing address:
  • Phone:
  • 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: KAYLA THOMAS
Title or Position: PMHNP-BC
Credential: PMHNP-BC
Phone: 410-490-9879