Healthcare Provider Details

I. General information

NPI: 1457034720
Provider Name (Legal Business Name): RENEWED MINDS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 CANNONS POINT LN # MC
MC DANIELS KY
40152-7017
US

IV. Provider business mailing address

602 CANNONS POINT LN
MC DANIELS KY
40152-7017
US

V. Phone/Fax

Practice location:
  • Phone: 270-668-4246
  • Fax:
Mailing address:
  • Phone: 270-668-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALELEA HEWITT
Title or Position: APRN
Credential:
Phone: 270-668-4246