Healthcare Provider Details

I. General information

NPI: 1538903117
Provider Name (Legal Business Name): HART SOUL & MIND HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 210
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 210
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-306-4477
  • Fax: 614-862-0837
Mailing address:
  • Phone: 614-306-4477
  • Fax: 614-862-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CONSTANCE R HARTGROVE
Title or Position: APRN
Credential: APRN
Phone: 614-306-4477