Healthcare Provider Details

I. General information

NPI: 1619881323
Provider Name (Legal Business Name): CONSCIOUS NATIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ROSE HILL DR
ABSECON NJ
08201-2502
US

IV. Provider business mailing address

204 ROSE HILL DR
ABSECON NJ
08201-2502
US

V. Phone/Fax

Practice location:
  • Phone: 609-354-7542
  • Fax: 936-241-0714
Mailing address:
  • Phone: 609-354-7542
  • Fax: 936-241-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KEIANDRA VINSON
Title or Position: NURSE PRACTITIONER
Credential: DNP, MBA,PMHNP
Phone: 609-354-7542