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CONSCIOUS CHANGE LLC
NPI 1275118036
Nurse Practitioner - Psychiatric/Mental Health in Oxford, MS

Active since March 12, 2021CLIA 25D2275016 · Waiver
507 HERITAGE DR STE 101, OXFORD, MS 38655(662) 638-3388(844) 728-9613 Get Directions Write a Review

NPPES record last updated: April 20, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 20, 2021, Mar 12, 2021 (2 updates tracked since 2021).

About Conscious Change Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONSCIOUS CHANGE LLC (NPI 1275118036) is a healthcare organization registered as a psychiatric/mental health in Oxford, Mississippi and active in the NPI registry since March 2021. The organization holds a CLIA Waiver certificate valid through January 12, 2027 and lists Krisna Hervey, Owner, as its authorized official.

NPPES Registry Identity

NPI1275118036
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameCONSCIOUS CHANGE LLC
Location Address507 HERITAGE DR STE 101Oxford, MS 38655-5571
Mailing AddressPo Box 2969Oxford, MS 38655-3001 · (662) 638-3388 · Fax (844) 728-9613
Phone(662) 638-3388
Fax(844) 728-9613
Organization SubpartNo
Authorized OfficialKrisna HerveyOwner · (662) 638-3388
Enumeration DateMarch 12, 2021
Last NPPES UpdateApril 20, 20212 updates tracked since enumeration
NPPES CertifiedApril 20, 2021
✔ NPI 1275118036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
507 HERITAGE DR STE 101, Oxford, MS 38655
Open in Google Maps ↗

Other Identifiers 1

Medicaid07784361MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2275016

Conscious Change LLC · Oxford, MS
Active · expires Jan 12, 2027
CLIA Number25D2275016
Laboratory TypePhysician Office
Certificate Effective DateJanuary 13, 2025
Certificate Expiration DateJanuary 12, 2027
Laboratory DirectorKrisna A. Hervey
Laboratory Phone(662) 638-3388
Laboratory LocationConscious Change LLC507 Heritage Dr Ste 101, Oxford, MS 38655
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHAMEKA MALONE NP
Nurse Practitioner (Psychiatric/Mental Health)
507 HERITAGE DR STE 101
OXFORD, MS 38655
Lafayette County (662) 638-3388
MRS. KRISNA ALYSE HERVEY MSN, PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
507 HERITAGE DR STE 101
OXFORD, MS 38655
Lafayette County (662) 638-3388

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Conscious Change LLC's NPI number?

The NPI number for Conscious Change LLC is 1275118036. It was assigned to this organization in the NPPES registry on March 12, 2021.

Where is Conscious Change LLC located?

Conscious Change LLC is located at 507 Heritage Dr Ste 101, Oxford, MS 38655. The listed phone number is (662) 638-3388.

What is Conscious Change LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Does Conscious Change LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2275016) is associated with this NPI, valid through January 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Conscious Change LLC was last updated on April 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.