# RISING PHOENIX MENTAL WELLNESS, PLLC

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

## Provider details

- **NPI number:** 1659208072
- **Authorized official:** KATELYN MCKIBBEN PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (814) 230-7921

## Contact information

- **Practice address:** 145 WATER ST, CONNEAUT LAKE, PA 16316-7279
- **Practice address phone:** (814) 230-7921
- **Practice address fax:** (814) 925-9348
- **Mailing address:** 145 WATER ST, CONNEAUT LAKE, PA 16316-7279
- **Mailing address phone:** (814) 230-7921
- **Mailing address fax:** (814) 925-9348

## 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:** 05/07/2026
- **Last updated:** 05/07/2026