# MAGNOLIA PSYCHIATRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255090510
- **Authorized official:** ANGEL SQUIRE PMHNP (OWNER)
- **Authorized official phone:** (615) 813-0726

## Contact information

- **Practice address:** 312 S 4TH ST STE 700, LOUISVILLE, KY 40202-3046
- **Practice address phone:** (615) 813-0726
- **Mailing address:** 4523 SHADY PLACE CT, BOWLING GREEN, KY 42104-4423
- **Mailing address phone:** (937) 285-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2021
- **Last updated:** 02/03/2022