MEDICARE: MINDFUL ROOTS WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1164371159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL ROOTS WELLNESS PLLC

Provider Business Mailing Address
First Line	:	414 WILLOW GROVE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2775
Country	:	US
Telephone Number	:	210-849-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 WILLOW GROVE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2775
Country	:	US
Telephone Number	:	210-849-1909
Fax Number	:	210-893-2345

Authorized Official
Title or Position	:	PMHNP
Name	:	KRISTA N PASQUALE
Credential	:
Telephone Number	:	210-840-1909

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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