Healthcare Provider Details

I. General information

NPI: 1831029966
Provider Name (Legal Business Name): MINDFUL MINDS HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 FRANKFORD AVE STE A
PHILA PA
19114-2846
US

IV. Provider business mailing address

9625 FRANKFORD AVE
PHILA PA
19114-2846
US

V. Phone/Fax

Practice location:
  • Phone: 267-278-7974
  • Fax:
Mailing address:
  • Phone: 267-278-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAWANAHA STOKES
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 267-278-7974