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General NPI Number Information
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NPI Number | 1891477501
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Entity Type | Organization
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Legal Business Name | PROSPERITY MENTAL WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 5906 CHARLOTTE PIKE STE D
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City | NASHVILLE
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State | TN
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Zip | 37209-3181
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Country | US
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Telephone | 615-828-0884
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Fax |
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Provider Business Mailing Address
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Address Line | 5906 CHARLOTTE PIKE STE D
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City | NASHVILLE
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State | TN
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Zip | 37209-3181
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Country | US
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Telephone | 615-828-0884
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Fax |
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Authorized Official
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Title or Position | OWNER, HEALTHCARE PROVIDER
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Name | STASHA NICOLE HAMPTON
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Credential | APRN, PMHNP-BC
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Telephone | 629-888-4161
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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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