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General NPI Number Information
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NPI Number | 1750159497
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Entity Type | Organization
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Legal Business Name | MIND OVER MOOD LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 10 BERKLEY RD
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City | BROOMALL
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State | PA
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Zip | 19008-2413
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Country | US
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Telephone | 610-978-6677
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Fax | 610-672-4753
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Provider Business Mailing Address
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Address Line | 10 BERKLEY RD
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City | BROOMALL
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State | PA
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Zip | 19008-2413
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Country | US
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Telephone | 610-978-6677
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Fax | 610-672-4753
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Authorized Official
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Title or Position | OWNER
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Name | MISS JAMIE KAKKANATTU
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Credential | CRNP
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Telephone | 610-978-6677
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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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