Healthcare Provider Details

I. General information

NPI: 1043083413
Provider Name (Legal Business Name): OPTIMISTIC WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 NW KENDALL CT
TOPEKA KS
66618-1269
US

IV. Provider business mailing address

5119 NW KENDALL CT
TOPEKA KS
66618-1269
US

V. Phone/Fax

Practice location:
  • Phone: 785-817-1893
  • Fax: 785-587-0009
Mailing address:
  • Phone: 785-817-1893
  • Fax: 785-578-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELDON B HAYNES
Title or Position: CONSULTANT
Credential: M.D.
Phone: 785-817-1893