Phoenixmides LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PHOENIXMIDES LLC

Practice address

591 Oakwood Cir
Petersburg, VA 23805-9339

Phone

(540) 204-2459

NPI assigned

Sep 18, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Oluwaseyi Oladipupo Soetan, PMHNP-BC

Title

Psychiatric Nurse Practitioner

Phone

(540) 204-2459

Specialties & licenses 1

Addresses

Other names 1

• Phoenixmides Mental Health & Wellness Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Oluwaseyi Ladipupo Soetan, PMHNP - BC

  • Psychiatric/Mental Health Nurse Practitioner
  • North Dinwiddie, VA
  • NPI 1932701984
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1023896586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5706 GOSSAMER CT",
            "city": "MOSELEY",
            "state": "VA",
            "postal_code": "231202339",
            "telephone_number": "154-020-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 OAKWOOD CIR",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059339",
            "telephone_number": "540-204-2459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIXMIDES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "SOETAN",
        "authorized_official_first_name": "OLUWASEYI",
        "authorized_official_middle_name": "OLADIPUPO",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "540-204-2459",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenixmides Mental Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phoenixmides Mental Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Latisha Renee Petty
• Justin Andrew Phillingane, D.P.M.
• Sarah Neal Phillips
• Phoenix N Peace LLC
• Phoenix-N-Peace Acr, Inc.
• Physician Associates LTD
• Chitra Pidaparti, PH.D.
• Joshua Paul Pidcoe
• Teisha N. Pink-Gonzalez
• Jeffrey Hall Pinsky, DPM

• Psychiatric/Mental Health Nurse Practitioner in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.