MIND AND BODY MEDICAL CLINIC (NPI# 1497223846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497223846 |
| Entity Type | Organization |
| Organization Name | MIND AND BODY MEDICAL CLINIC |
| Practice Address |
2216 Nw 164th St Ste A Edmond OK 73013-9078 |
| Practice Telephone | 4052854755 |
| Practice Fax Number | 4052153760 |
| Mailing Telephone | 4052854755 |
| Mailing Fax Number | 4052153760 |
| Enumeration Date | 2018-11-04 |
| Last Update Date | 2018-11-04 |
| Authorized Official Name | KELLI LEEK (CO-OWNER) |
| Authorized Official Telephone | 4052854755 |
| Authorized Official Credential | APRN-CNS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0301X |
Psychiatry & Neurology Specialization: Brain Injury Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2084V0102X |
Psychiatry & Neurology Specialization: Vascular Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 364SC0200X |
Clinical Nurse Specialist Specialization: Critical Care Medicine |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 364SN0800X |
Clinical Nurse Specialist Specialization: Neuroscience |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Street Address |
2216 NW 164TH ST STE A |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-9078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558658138 | J Dustin Rosenhamer | Psychiatry & Neurology | 2216 Nw 164th St, Ste A, Edmond, OK 73013-9078 | 2011-07-05 |
| 1952587503 | Amer Badreden Nouh | Psychiatry & Neurology | 1417 Nw 150th St, Edmond, OK 73013-1305 | 2008-01-14 |
| 1750594099 | Travis Kanaly | Psychiatry & Neurology | 1705 Renaissance Blvd Ste 120, Edmond, OK 73013 | 2007-05-07 |
| 1740215169 | David L Smith | Psychiatry & Neurology | 1257 E 33rd St, Edmond, OK 73013-6307 | 2006-07-12 |
| 1992762272 | Carissa Temple Candler | Psychiatry & Neurology | 120 N Bryant Ave, Suite A-6, Edmond, OK 73034-6302 | 2006-04-28 |
| 1740626365 | Carissa Candler Md Pllc | Psychiatry & Neurology | 120 N Bryant Ave, Suite A-6, Edmond, OK 73034-6302 | 2013-05-22 |
| 1659678340 | Ellen E Hope M D Inc | Psychiatry & Neurology | 125 E 3rd St, Edmond, OK 73034-3821 | 2011-02-16 |
| 1184952798 | Deborah L. Nilson, Do PC | Psychiatry & Neurology | 3855 S Boulevard St, Suite 400, Edmond, OK 73013-5498 | 2009-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871110478 | Noor Mahmoud | Psychiatry & Neurology | 825 Ne 10th St Ste 5200, Oklahoma City, OK 73104-5417 | 2020-06-30 |
| 1407337462 | Opus Medical, LLC | Psychiatry & Neurology | 4 Ne 10th St Suite 467, Oklahoma City, OK 73104 | 2018-08-27 |
| 1295229268 | Veronica Astrid Moreno Gomez | Psychiatry & Neurology | 920 Stanton L Young Blvd Ste Wp-2040, Oklahoma City, OK 73104-5036 | 2018-06-21 |
| 1326558180 | Comanche County Healthcare Corporation | Psychiatry & Neurology | 3201 W Gore Blvd Ste 300, Lawton, OK 73505-6350 | 2017-10-06 |
| 1033632716 | Sergio Ramirez | Psychiatry & Neurology | 920 Staton L. Young Blvd., Suite Wp-2040, Oklahoma City, OK 73104 | 2017-07-25 |
| 1407376890 | Temitope Ayodeji Lawal | Psychiatry & Neurology | 920 Stanton L Young Blvd # W2040, Oklahoma City, OK 73104-5036 | 2017-06-26 |
| 1932637030 | Marina Aleksandrovna Kravtsova | Psychiatry & Neurology | 920 Stanton L Young Blvd Ste Wp2040, Oklahoma City, OK 73104-5036 | 2017-06-01 |
| 1013379627 | Pono Neuromonitoring, Pllc | Psychiatry & Neurology | 3334 W Main St # 518, Norman, OK 73072-4805 | 2016-03-23 |
| 1255710117 | Jason King | Psychiatry & Neurology | 226 Se Debell Ave Ste B, Bartlesville, OK 74006-2300 | 2015-05-26 |
| 1508256165 | George Alexander Curry II | Psychiatry & Neurology | 9615 Prosper Dr, Oklahoma City, OK 73151-8801 | 2015-02-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.