=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821989310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST MIND AND BODY HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2025
-----------------------------------------------------
Last Update Date | 09/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11711 ARBOR ST STE 240B
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-2979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-217-5257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7427 CASTLE ST
-----------------------------------------------------
City | PAPILLION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68046-4716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-217-5257
-----------------------------------------------------
Fax | 949-864-3749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, NURSE PRACTITIONER
-----------------------------------------------------
Name | KIMBERLY A WOHLWEND
-----------------------------------------------------
Credential | FNP-BC, PMHNP-BC
-----------------------------------------------------
Telephone | 531-217-5257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------