Organization
MINDFULL, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXIAN H ODOM PMHNP-BC (OWNER)
(601) 825-6010
Entity
Organization
Contact information
Practice address
1776 HIGHWAY 49 S, FLORENCE, MS 39073-9429
(601) 825-6010
(601) 825-7146
Mailing address
1776 HIGHWAY 49 S, FLORENCE, MS 39073-9429
(601) 825-6010
(601) 825-7146
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04309701
—
MS
Enumeration date
08/29/2019
Last updated
10/13/2022
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