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General NPI Number Information
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NPI Number | 1659208072
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Entity Type | Organization
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Legal Business Name | RISING PHOENIX MENTAL WELLNESS, PLLC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 145 WATER ST
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City | CONNEAUT LAKE
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State | PA
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Zip | 16316-7279
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Country | US
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Telephone | 814-230-7921
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Fax | 814-925-9348
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Provider Business Mailing Address
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Address Line | 145 WATER ST
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City | CONNEAUT LAKE
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State | PA
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Zip | 16316-7279
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Country | US
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Telephone | 814-230-7921
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Fax | 814-925-9348
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | KATELYN MCKIBBEN
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Credential | PMHNP-BC
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Telephone | 814-230-7921
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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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