Evibrant Mental Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

EVIBRANT MENTAL WELLNESS

Practice address

3122 Nealy Way Ste 201
Longview, TX 75605-1092

Phone

(903) 833-9875

NPI assigned

Aug 18, 2023

Organization subpart

No

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

Authorized official

Name

Keisha Marsolan, PMHNP-BC

Title

Owner/Ceo

Phone

(903) 452-0680

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1093598302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 NORTHWOOD CT",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3122 NEALY WAY STE 201",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756051092",
            "telephone_number": "903-833-9875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVIBRANT MENTAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "MARSOLAN",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "903-452-0680",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Longview, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.