NPIMap

Organization Active NPI

Mind & Body Wellness, PLLC

  • Primary Care Nurse Practitioner
  • Shelby, NC
National Provider Identifier
1134713159
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
MIND & BODY WELLNESS, PLLC
Practice address
3603 W Stage Coach TRL
Shelby, NC 28150-9598
Phone
(910) 387-3840
Fax
(704) 703-9668
NPI assigned
Feb 22, 2021
Last updated
May 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2026

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

Authorized official

Name
Leistey Elise TindallNPI 1326588492
Title
Owner
Phone
(910) 387-3840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

3603 W Stage Coach TRL
Shelby, NC 28150-9598

Mailing address

3603 W Stage Coach TRL
Shelby, NC 28150-9598
Phone (704) 476-9144

Other identifiers 1

IdentifierTypeStateIssuer
9032489075MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address emichele@mindandbodywellnesspllc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210318000494 NC Part B Supplier - Clinic/Group Practice 5698182608 Receives reassigned benefits from 6 practitioners
Practice locations: Rockingham, NC
O20250424002879 FL Part B Supplier - Clinic/Group Practice 5698182608 Receives reassigned benefits from 3 practitioners
Practice locations: Rockingham, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1134713159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3603 W STAGE COACH TRL",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281509598",
            "telephone_number": "704-476-9144",
            "fax_number": "704-703-9668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3603 W STAGE COACH TRL",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281509598",
            "telephone_number": "910-387-3840",
            "fax_number": "704-703-9668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND & BODY WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-22",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "TINDALL",
        "authorized_official_first_name": "LEISTEY",
        "authorized_official_middle_name": "ELISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-387-3840"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9032489075",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emichele@mindandbodywellnesspllc.com",
            "affiliation": "N",
            "endpointDescription": "Private Company Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "329 Silver Grove Church Rd",
            "city": "Rockingham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283796978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.