PHOENIXMIDES LLC NPI 1023896586

NPI Information

  • NPI: 1023896586
  • Provider Name: PHOENIXMIDES LLC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Doing Business As: PHOENIXMIDES MENTAL HEALTH & WELLNESS
  • Address: 591 OAKWOOD CIR
    PETERSBURG, VA
    ZIP 23805
  • Phone: (540) 204-2459

Map and Directions

Get Directions

NPI Details

PHOENIXMIDES LLC is a psychiatric/mental health nurse practitioner in Petersburg, VA. PHOENIXMIDES LLC NPI is 1023896586. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Phoenixmides Mental Health & Wellness.

The provider's business location address is:

591 OAKWOOD CIR
PETERSBURG, VA
ZIP 23805-339
Phone: (540) 204-2459

The provider's authorized official is Oluwaseyi Oladipupo Soetan .
The authorized official title is Psychiatric Nurse Practitioner and has the following contact phone number (540) 204-2459.

The enumeration date for this NPI number is 9/18/2023 and was last updated on 2/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI