Organization · Type 2 NPI

Phoenixmides LLC

Psychiatric/Mental Health Nurse Practitioner · Petersburg, VA

NPI number 1023896586 Active

Practice location

591 Oakwood Cir
Petersburg, VA 23805-9339

Call (540) 204-2459 Map

Mailing address

5706 Gossamer Ct
Moseley, VA 23120-2339

Specialties and licenses

Taxonomy	Code	License
Psychiatric/Mental Health Nurse Practitioner Primary	363LP0808X	None listed

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

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NPI record

NPI: 1023896586
Entity type: Organization (Type 2)
Issued: Sep 18, 2023
Last updated: Feb 12, 2024
Status: Active

Other names

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Phoenixmides Mental Health & Wellness · doing business as
Phoenixmides Mental Health & Wellness · doing business as

Authorized official

Oluwaseyi Oladipupo Soetan, PMHNP-BC
Psychiatric Nurse Practitioner
(540) 204-2459

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1023896586

Phoenixmides LLC's National Provider Identifier is 1023896586, issued on Sep 18, 2023. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Petersburg, VA. The record was last updated on Feb 12, 2024.