Organization
MIND REBIRTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKIE MICHELLE JOHNSON (NURSE PRACTITIONER)
(901) 208-6984
Entity
Organization
Contact information
Practice address
3923 RIDGEDALE ST, MEMPHIS, TN 38127-4036
(901) 208-6984
Mailing address
3923 RIDGEDALE ST, MEMPHIS, TN 38127-4036
(901) 208-6984
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/12/2022
Last updated
08/12/2022
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