Organization
GRACEFUL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIDRA THOMPSON PMHNP-BC (MANAGING MEMBER)
(601) 953-1504
Entity
Organization
Contact information
Practice address
2616 SOUTHERLAND ST STE 100, JACKSON, MS 39216-4855
(601) 953-1504
(601) 866-1674
Mailing address
1783 JONES LOOP, TERRY, MS 39170-9013
(601) 953-1504
(601) 866-1674
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/14/2025
Last updated
03/04/2025
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