| First Coast Mental Health P A | |
|
1409 Kingsley Ave Ste 8 Orange Park FL 32073-4553 | |
| (904) 269-7200 | |
| (904) 269-0070 |
| Full Name | First Coast Mental Health P A |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1409 Kingsley Ave Ste 8, Orange Park, Florida |
| Authorized Official Name and Position | Melody D Taylor (OFFICE MANAGER) |
| Authorized Official Contact | 9042697200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Coast Mental Health P A 1409 Kingsley Ave Ste 8 Orange Park FL 32073-4553 Ph: (904) 269-7200 | First Coast Mental Health P A 1409 Kingsley Ave Ste 8 Orange Park FL 32073-4553 Ph: (904) 269-7200 |
| NPI Number | 1285884650 |
|---|---|
| Provider Enumeration Date | 09/23/2008 |
| Last Update Date | 10/19/2022 |
| Certification Date | 10/19/2022 |
| Medicare PECOS PAC ID | 1658435482 |
|---|---|
| Medicare Enrollment ID | O20090122000705 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285884650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME100502 (Florida) | Primary |
| Provider Name | Kathleen B Grissett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821170085 PECOS PAC ID: 7113081944 Enrollment ID: I20090122000693 |
| Provider Name | Angela White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447473483 PECOS PAC ID: 6608064050 Enrollment ID: I20101229000399 |
| Provider Name | Carl F Holmes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104841311 PECOS PAC ID: 1759556905 Enrollment ID: I20111216000098 |
| Provider Name | Nicole Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235716697 PECOS PAC ID: 8729485115 Enrollment ID: I20210928002077 |
| Provider Name | Aimee Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841936952 PECOS PAC ID: 8123401072 Enrollment ID: I20220810002242 |
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