Mind and Body Wellness, LLC.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MIND AND BODY WELLNESS, LLC.

Practice address

720 Lexington Ave
Fort Smith, AR 72901-4738

Phone

(479) 910-3169

Fax

(479) 600-5051

NPI assigned

Jun 14, 2023

Organization subpart

No

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

Authorized official

Name

Lucinda J ShepherdNPI 1881000875

Title

Owner

Phone

(479) 409-6049

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Mind and Body Wellness, LLC. Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 6

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

• Harry A Lazarte, M.D.

  • Internal Medicine Physician
  • Springdale, AR
  • NPI 1548486053
  Medicare reassignment NPD
• Kirsten Orange, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Springdale, AR
  • NPI 1881167666
  Medicare reassignment NPD
• Maylynn D York, LPC-S

  • Professional Counselor
  • Fort Smith, AR
  • NPI 1740355437
  Medicare reassignment NPD
• Lucinda Shepherd

  • Counselor
  • Springdale, AR
  • NPI 1881000875
  NPD Authorized official
• Reagan Villines, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Smith, AR
  • NPI 1982418984
  NPD
• Ashley Nicole McKinney, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Smith, AR
  • NPI 1235845017
  NPD (past)

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1508540956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6632",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727666632",
            "telephone_number": "479-409-6049",
            "fax_number": "479-600-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 LEXINGTON AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729014738",
            "telephone_number": "479-910-3169",
            "fax_number": "479-600-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND AND BODY WELLNESS, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-14",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "LUCINDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-409-6049"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "322060002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind and Body Wellness, LLC.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mind and Body Wellness, LLC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kennedy Grace Mills
• William R Mills, LPN
• Ashleigh Milne
• Genie Anne-Marie Milone, CNP
• Christopher Daniel Milstead, APRN-CNP
• Adawnda J Minnie, BA
• Abigail Mino
• Muhammad Qasim Salar Mir, M.D
• Angela Kay Miranda, MHPP
• Pooja Mishra, MD

• Multi-Specialty Clinic/Center in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Multi-Specialty Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.