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General NPI Number Information
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NPI Number | 1962278507
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Entity Type | Organization
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Legal Business Name | ENLIGHTEN MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 600 MONTICELLO ST STE 1
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City | SOMERSET
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State | KY
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Zip | 42501-2974
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Country | US
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Telephone | 606-400-2227
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Fax | 606-332-0576
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Provider Business Mailing Address
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Address Line | PO BOX 142
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City | BURNSIDE
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State | KY
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Zip | 42519-0142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP/NURSE PRACTITIONER
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Name | MRS. MISTY GOLDSON
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Credential | APRN
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Telephone | 606-400-2227
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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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