Healthcare Provider Details

I. General information

NPI: 1467044560
Provider Name (Legal Business Name): INVIGORATING MIND & BODY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 THIMBLE SHOALS BLVD STE 203A
NEWPORT NEWS VA
23606-4512
US

IV. Provider business mailing address

610 THIMBLE SHOALS BLVD STE 203A
NEWPORT NEWS VA
23606-4512
US

V. Phone/Fax

Practice location:
  • Phone: 757-775-8837
  • Fax: 949-561-4700
Mailing address:
  • Phone: 757-775-8837
  • Fax: 949-561-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAKEYSHA RENEE JENKINS
Title or Position: NP/OWNER
Credential: AGPCNP-BC, PMHNP-BC
Phone: 757-775-8837