Healthcare Provider Details

I. General information

NPI: 1306758313
Provider Name (Legal Business Name): FREE YOUR MIND PSYCHIATRIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 S FORT APACHE RD
LAS VEGAS NV
89148-7657
US

IV. Provider business mailing address

5510 S FORT APACHE RD
LAS VEGAS NV
89148-7657
US

V. Phone/Fax

Practice location:
  • Phone: 725-215-6340
  • Fax: 725-527-1853
Mailing address:
  • Phone: 725-215-6340
  • Fax: 725-527-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. FERNANDA JOHNSTON
Title or Position: PMHNP
Credential: PMHNP-BC, FNP
Phone: 615-668-4665