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General NPI Number Information
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NPI Number | 1366247116
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Entity Type | Organization
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Legal Business Name | K.C CARE FOR THE MIND LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 118 W STATE ROAD 434
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-2551
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Country | US
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Telephone | 407-890-9888
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Fax | 877-405-6396
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Provider Business Mailing Address
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Address Line | 4478 OAK ARBOR CIR
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City | ORLANDO
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State | FL
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Zip | 32808-5966
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Country | US
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Telephone | 424-414-3560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAISSA MURIELLE DYWOU KOUEDE
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Credential | APRN
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Telephone | 424-414-3560
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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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