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General NPI Number Information
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NPI Number | 1467044560
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Entity Type | Organization
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Legal Business Name | INVIGORATING MIND & BODY HEALTHCARE PLLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 03/20/2021
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Provider Practice Location Address
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Address Line | 610 THIMBLE SHOALS BLVD STE 203A
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4512
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Country | US
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Telephone | 757-775-8837
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Fax | 949-561-4700
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Provider Business Mailing Address
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Address Line | 610 THIMBLE SHOALS BLVD STE 203A
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4512
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Country | US
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Telephone | 757-775-8837
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Fax | 949-561-4700
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Authorized Official
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Title or Position | NP/OWNER
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Name | LAKEYSHA RENEE JENKINS
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Credential | AGPCNP-BC, PMHNP-BC
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Telephone | 757-775-8837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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