Mindbody Health & Wellness Clinic LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MINDBODY HEALTH & WELLNESS CLINIC LLC

Practice address

415 State St.
Natchez, MS 39120

Phone

(769) 355-2138

NPI assigned

Mar 13, 2024

Organization subpart

No

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

Authorized official

Name

Ursula Brooks-ClemonsNPI 1558727560

Title

Owner

Phone

(769) 355-2138

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 1

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

• Ursula Shene Brooks-Clemons, FPMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • McComb, MS
  • NPI 1558727560
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1750140786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 NORTHAMPTON RD",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391205274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 STATE ST.",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "39120",
            "telephone_number": "769-355-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBODY HEALTH & WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-13",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "BROOKS-CLEMONS",
        "authorized_official_first_name": "URSULA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "769-355-2138"
    },
    "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": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Natchez, MS
• Providers in Natchez, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.