REVIVING MINDS LLC (NPI# 1669856514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669856514 |
| Entity Type | Organization |
| Organization Name | REVIVING MINDS LLC |
| Practice Address |
112 Innwood Dr Ste H Covington LA 70433-9134 |
| Mailing Address |
70380 Highway 21 Ste 2 Covington LA 70433-8128 |
| Practice Telephone | 9858930693 |
| Practice Fax Number | 9857907090 |
| Mailing Telephone | 9858930693 |
| Mailing Fax Number | 9857907090 |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2015-12-09 |
| Authorized Official Name | KELA SPIKES BICKHAM (OWNER/NURSE PRACTITIONER) |
| Authorized Official Telephone | 9858930693 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP08162 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
112 INNWOOD DR STE H |
| City | COVINGTON |
| State | LA |
| Zip Code | 70433-9134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578953139 | Kela Spikes Bickham | Nurse Practitioner | 112 Innwood Dr Ste H, Covington, LA 70433-9134 | 2015-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790301018 | Caroline K. Wilson | Speech-Language Pathologist | 19105 Sandy Lane Suite A, Covington, LA 70433 | 2020-06-23 |
| 1568092013 | Tracy T Aljabi | Nurse Practitioner | 648 Crestwood Dr., Covington, LA 70433 | 2020-01-23 |
| 1093365462 | Maria Robert Hebrock | Marriage & Family Therapist | 71338 La-21, Suite 101, Covington, LA 70433 | 2019-09-17 |
| 1750930806 | Terry Fink Troxler | Speech-Language Pathologist | 521 Covington Point Dr, Covington, LA 70433 | 2019-09-10 |
| 1780231589 | Margaret Nordness Favre | Behavioral Analyst | 3999 Us-190, Covington, LA 70433 | 2019-08-26 |
| 1881241180 | Jennifer Ann Bacile | Counselor | 604 E 15th Street, Covington, LA 70433 | 2019-08-21 |
| 1356906689 | Moving and Caring Transportation LLC | Non-emergency Medical Transport (VAN) | 251 Vintage Drive, Covington, LA 70433 | 2019-05-02 |
| 1780153874 | Nga Endoscopy Center LLC | Clinic/Center | 7015 Hwy 190 E Service Road Suite 103, Covington, LA 70433 | 2018-11-19 |
| 1831667229 | Geauxprodme | Durable Medical Equipment & Medical Supplies | 1304 Champagne Street, Covington, LA 70433 | 2018-11-05 |
| 1376037994 | Pamela Ann Bernabo | Specialist/Technologist, Other | 80 Maison Drive, Covington, LA 70433 | 2018-06-18 |
| Find all providers in zip 70433 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578953139 | Kela Spikes Bickham | Nurse Practitioner | 112 Innwood Dr Ste H, Covington, LA 70433-9134 | 2015-02-03 |
| 1689933236 | Kelly Ann Robinson | Nurse Practitioner | 70372 5th St, Covington, LA 70433-5423 | 2012-05-16 |
| 1144839457 | George Andrew Darling | Nurse Practitioner | 513 Madison Ave, Covington, KY 41011-1505 | 2020-07-23 |
| 1750915310 | Jennifer Lane Dufriend | Nurse Practitioner | 201 Greenbrier Blvd, Covington, LA 70433-7236 | 2020-02-23 |
| 1912550526 | Justin Branham | Nurse Practitioner | 1401 Madison Ave, Covington, KY 41011-3313 | 2019-07-23 |
| 1053878611 | Melissa Ellis | Nurse Practitioner | 201 Greenbrier Blvd, Covington, LA 70433-7236 | 2019-03-01 |
| 1740633221 | Kylie Eckert | Nurse Practitioner | 513 Madison Ave, Covington, KY 41011-1562 | 2016-07-19 |
| 1396149951 | Sarah Dietrich | Nurse Practitioner | 1997 Highway 51 S, Covington, TN 38019-3630 | 2014-10-10 |
| 1487919353 | Living Wellness LLC | Nurse Practitioner | 70372 5th St, Covington, LA 70433-5423 | 2012-07-06 |
| 1265790380 | Celeste Marie Lewis | Nurse Practitioner | 201 Holiday Blvd, Suite 120, Covington, LA 70433-5088 | 2012-04-26 |
| Find all providers in COVINGTON | ||||
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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.