Individual
KIM FREDRICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1200 W GRANADA BLVD STE 4, ORMOND BEACH, FL 32174-8157
(386) 983-4147
Mailing address
1200 W GRANADA BLVD STE 4, ORMOND BEACH, FL 32174-8157
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
RN9508898
FL
2084P0005X
Neurodevelopmental Disabilities Physician
RN9508898
FL
2084P0800X
Psychiatry Physician
RN9508898
FL
2084P0802X
Addiction Psychiatry Physician
RN9508898
FL
2084P0805X
Geriatric Psychiatry Physician
RN9508898
FL
Other
Enumeration date
07/30/2026
Last updated
07/30/2026
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