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General NPI Number Information
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NPI Number | 1073022950
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Entity Type | Organization
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Legal Business Name | MIND AND BODY CONNECTIONS LLC
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Dates
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Enumeration Date | 09/24/2017
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 117 MARIE STREET
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City | SUNSET
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State | LA
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Zip | 70584
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Country | US
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Telephone | 337-678-0366
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Fax | 337-223-8301
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Provider Business Mailing Address
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Address Line | 2161 BABE ST
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City | OPELOUSAS
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State | LA
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Zip | 70570-3252
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Country | US
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Telephone | 337-290-0745
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WRONETTA CHARLES
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Credential | APRN, FNP-BC, PMHNP-
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Telephone | 337-290-0745
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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 | AP04507
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License Number State | LA
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