# WELL SPACE NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Orange Family Psychiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184376055
- **Authorized official:** KIMBERLY JACKSON PMHNP (OWNER)
- **Authorized official phone:** (347) 696-1375

## Contact information

- **Practice address:** 266 BROADWAY STE 401, BROOKLYN, NY 11211-6306
- **Practice address phone:** (347) 696-1375
- **Practice address fax:** (914) 222-8973
- **Mailing address:** 266 BROADWAY STE 401, BROOKLYN, NY 11211-6306
- **Mailing address phone:** (347) 696-1375
- **Mailing address fax:** (914) 222-8973

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/21/2022
- **Last updated:** 01/29/2026