Healthcare Provider Details

I. General information

NPI: 1932054921
Provider Name (Legal Business Name): GIFTEDHAND INTEGRATIVE HEALTH & BEHAVIORAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12423 STONEBORO CT
FORT WAYNE IN
46845-9570
US

IV. Provider business mailing address

12423 STONEBORO CT
FORT WAYNE IN
46845-9570
US

V. Phone/Fax

Practice location:
  • Phone: 832-578-4056
  • Fax: 260-327-4551
Mailing address:
  • Phone: 317-561-0525
  • Fax: 260-327-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUFUNKE PATIENCE MOMOH
Title or Position: MANAGING MEMBER
Credential: DNP
Phone: 317-561-0525