EXTRAORDINARY MINDS NPI 1538856398

NPI Information

  • NPI: 1538856398
  • Provider Name: EXTRAORDINARY MINDS
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 532 OLD MARLTON PIKE W
    SUITE 510
    EVESHAM, NJ
    ZIP 08053
  • Phone: (856) 242-2121

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NPI Details

EXTRAORDINARY MINDS is a psychiatric/mental health nurse practitioner in Evesham, NJ. EXTRAORDINARY MINDS NPI is 1538856398. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

532 OLD MARLTON PIKE W
SUITE 510
EVESHAM, NJ
ZIP 08053
Phone: (856) 242-2121
Fax: (856) 242-2121

The provider's authorized official is Karen Wallace .
The authorized official title is Credentialing and has the following contact phone number (470) 446-5360.

The enumeration date for this NPI number is 4/21/2023 and was last updated on 4/21/2023.

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

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