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General NPI Number Information
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NPI Number | 1689487639
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Entity Type | Organization
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Legal Business Name | MINDFUL OVER MATTER PSYCHIATRY & WELLNESS DBA MINDFUL OVER MATTER
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1261 S CONGRESS AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-5172
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Country | US
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Telephone | 561-814-8143
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Fax | 855-526-7606
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Provider Business Mailing Address
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Address Line | 11017 MULBERRY GARDEN TRL
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-5091
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Country | US
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Telephone | 561-814-8143
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA KOFMAN
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Credential | FNP-BC, PMHNP-BC
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Telephone | 561-814-8143
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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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