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General NPI Number Information
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NPI Number | 1023890217
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Entity Type | Organization
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Legal Business Name | LIGHT HEARTED WELLNESS CARE, LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 10003 COURTVIEW LN STE E
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6682
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Country | US
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Telephone | 804-322-3054
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Fax | 804-884-3695
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Provider Business Mailing Address
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Address Line | 8708 HOLLYHEDGE LN
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-4051
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Country | US
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Telephone | 301-526-8924
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Fax | 804-884-3695
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACITIONER
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Name | KIMBERLY SHAWN FIELDS
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Credential | PMHNP
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Telephone | 301-526-8924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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