Healthcare Provider Details

I. General information

NPI: 1710855028
Provider Name (Legal Business Name): MIND-BODY CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 DARBY AVE
LAMBERT MS
38643
US

IV. Provider business mailing address

PO BOX 814
LAMBERT MS
38643-0814
US

V. Phone/Fax

Practice location:
  • Phone: 662-351-4225
  • Fax: 662-351-4225
Mailing address:
  • Phone: 662-351-4225
  • Fax: 662-351-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KARMESHA DUKE
Title or Position: NURSE PRACTITIONER
Credential: AGPCNP-BC
Phone: 662-351-4225