Organization
MINDSET & RECOVERY DIVERSIFIED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHATRIENA D JOHNSON APRN (PMHNP-BC)
(772) 208-8734
Entity
Organization
Contact information
Practice address
6633 WOODS ISLAND CIR APT 206, PORT ST LUCIE, FL 34952-1475
(772) 208-8734
(772) 667-5186
Mailing address
11582 SW VILLAGE PKWY # 1262, PORT ST LUCIE, FL 34987-2392
(772) 208-8734
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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