MINDCLUB KENTUCKY LLC NPI 1033005079

NPI Information

  • NPI: 1033005079
  • Provider Name: MINDCLUB KENTUCKY LLC
  • Classification: Nurse Practitioner - 363LP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 111 DERRICK PL
    HOPKINSVILLE, KY
    ZIP 42240
  • Phone: (833) 833-9655

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NPI Details

MINDCLUB KENTUCKY LLC is a primary care nurse practitioner in Hopkinsville, KY. MINDCLUB KENTUCKY LLC NPI is 1033005079. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

111 DERRICK PL
HOPKINSVILLE, KY
ZIP 42240-325
Phone: (833) 833-9655

The provider's authorized official is Kathy Richardson .
The authorized official title is Vp, Cao and has the following contact phone number (615) 390-2865.

The enumeration date for this NPI number is 6/16/2025 and was last updated on 6/16/2025.

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
1101YA0400XCounselorAddiction (Substance Use Disorder)No
2101YM0800XCounselorMental HealthNo
3101Y00000XCounselorNo
4363LP2300XNurse PractitionerPrimary CareYes

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

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