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General NPI Number Information
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NPI Number | 1477347615
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Entity Type | Organization
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Legal Business Name | DIVERSE WELLNESS SOLUTIONS
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 7580 NW 5TH ST UNIT 15614
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City | PLANTATION
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State | FL
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Zip | 33318-8427
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Country | US
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Telephone | 888-212-1949
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Fax | 888-281-6026
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Provider Business Mailing Address
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Address Line | 7580 NW 5TH ST UNIT 15614
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City | PLANTATION
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State | FL
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Zip | 33318-8427
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Country | US
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Telephone | 888-212-1949
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Fax | 888-281-6026
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | KYNDALL NYESCHELLE MAMMAH
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Credential | FNP
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Telephone | 888-212-1949
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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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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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