Healthcare Provider Details

I. General information

NPI: 1790648368
Provider Name (Legal Business Name): MIND-BODY CONNECTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 MCDAVID AVE SUITE A
LAMBERT MS
38643
US

IV. Provider business mailing address

PO BOX 81
LAMBERT MS
38643-0081
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KARMESHA DUKE
Title or Position: CO-OWNER
Credential:
Phone: 662-351-4225