Provider Demographics
NPI:1104702331
Name:BLOSSOM WELLNESS & PSYCHIATRY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:BLOSSOM WELLNESS & PSYCHIATRY PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, APRN
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARRON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, APRN
Authorized Official - Phone:864-337-3013
Mailing Address - Street 1:144 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9067
Mailing Address - Country:US
Mailing Address - Phone:864-337-3013
Mailing Address - Fax:
Practice Address - Street 1:144 FALCON CT
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:SC
Practice Address - Zip Code:29653-9067
Practice Address - Country:US
Practice Address - Phone:864-337-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty