=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710855028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND-BODY CONNECTION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 DARBY AVE
-----------------------------------------------------
City | LAMBERT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-351-4225
-----------------------------------------------------
Fax | 662-351-4225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 814
-----------------------------------------------------
City | LAMBERT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38643-0814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-351-4225
-----------------------------------------------------
Fax | 662-351-4225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | KARMESHA DUKE
-----------------------------------------------------
Credential | AGPCNP-BC
-----------------------------------------------------
Telephone | 662-351-4225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------