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General NPI Number Information
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NPI Number | 1083314629
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Entity Type | Organization
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Legal Business Name | BLOOM BEHAVIORAL HEALTH & WELLNESS, PLLC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 200 S RHODES ST STE E
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-4213
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Country | US
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Telephone | 662-912-6024
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Fax | 662-265-9483
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Provider Business Mailing Address
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Address Line | 2416 FALLINGWATER LN APT 102
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City | CORDOVA
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State | TN
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Zip | 38016-7686
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Country | US
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Telephone | 901-870-8624
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Fax | 662-265-9483
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | CHARLEDRIA MCGEE
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Credential | DNP, PMHNP
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Telephone | 901-870-8624
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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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