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General NPI Number Information
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NPI Number | 1043975048
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Entity Type | Organization
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Legal Business Name | MINDFUL INNOVATIONS
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 4154 MENDENHALL OAKS PKWY STE 103
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City | HIGH POINT
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State | NC
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Zip | 27265-8034
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Country | US
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Telephone | 336-847-1626
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 DOUBLE POND LN
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City | HIGH POINT
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State | NC
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Zip | 27265-9242
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Country | US
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Telephone | 336-847-1626
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CRYSTAL JENITA MONTAGUE
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Credential |
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Telephone | 336-847-1626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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