Organization
COASTLINE NEUROPSYCHIATRIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN NEIL GROOM PH.D. (OWNER)
(850) 341-4896
Entity
Organization
Contact information
Practice address
890 S PALAFOX ST SUITE 300-L, PENSACOLA, FL 32502
(850) 341-4896
(850) 433-1996
Mailing address
304 W GADSDEN ST, PENSACOLA, FL 32501
(850) 341-4896
(850) 433-1996
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
06/26/2023
Last updated
10/06/2023
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