Healthcare Provider Details

I. General information

NPI: 1386268142
Provider Name (Legal Business Name): INTEGRAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 NEWTOWN RD STE 115
VIRGINIA BEACH VA
23462-5758
US

IV. Provider business mailing address

1216 GRANBY ST
NORFOLK VA
23510-2607
US

V. Phone/Fax

Practice location:
  • Phone: 757-204-1901
  • Fax:
Mailing address:
  • Phone: 757-204-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NAKESHIA LYNN MOUZON
Title or Position: OWNER
Credential: FNP-C, PMHNP-BC
Phone: 757-204-1901