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General NPI Number Information
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NPI Number | 1598465551
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Entity Type | Organization
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Legal Business Name | BRIGHT SOUL WELLNESS CENTER INC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2186 W US HIGHWAY 40
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City | BRAZIL
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State | IN
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Zip | 47834-7201
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Country | US
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Telephone | 812-878-8223
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Fax | 812-443-0668
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Provider Business Mailing Address
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Address Line | 2186 W US HIGHWAY 40
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City | BRAZIL
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State | IN
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Zip | 47834-7201
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Country | US
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Telephone | 812-878-8223
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Fax |
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Authorized Official
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Title or Position | OWNER/FNP
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Name | MARANDA MCKINNEY
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Credential | DNP
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Telephone | 812-878-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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