| Impower, Inc. | |
|
2290 N Ronald Reagan Blvd Ste 116 Longwood FL 32750-3534 | |
| (407) 331-8002 | |
| (407) 331-8659 |
| Full Name | Impower, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2290 N Ronald Reagan Blvd Ste 116, Longwood, Florida |
| Authorized Official Name and Position | Anna Marie Kesic (CEO) |
| Authorized Official Contact | 4072150095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impower, Inc. 2290 N Ronald Reagan Blvd Ste 116 Longwood FL 32750-3534 Ph: (407) 215-0095 | Impower, Inc. 2290 N Ronald Reagan Blvd Ste 116 Longwood FL 32750-3534 Ph: (407) 331-8002 |
| NPI Number | 1104910868 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 07/22/2022 |
| Certification Date | 07/22/2022 |
| Medicare PECOS PAC ID | 6507924883 |
|---|---|
| Medicare Enrollment ID | O20081015000736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104910868 | NPI | - | NPPES |
| 360212502 | Medicaid | FL | |
| 013827000 | Medicaid | FL | |
| 006714202 | Medicaid | FL | |
| 006714203 | Medicaid | FL | |
| 360212500 | Medicaid | FL | |
| 360212505 | Medicaid | FL | |
| 006714200 | Medicaid | FL | |
| 006714201 | Medicaid | FL | |
| 759027000 | Medicaid | FL | |
| 005979100 | Medicaid | FL | |
| 007186500 | Medicaid | FL |
| Provider Name | Kelvin Dupera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285216234 PECOS PAC ID: 6800273335 Enrollment ID: I20220521000286 |
| Provider Name | Melissa Ann Colton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972588283 PECOS PAC ID: 0143678318 Enrollment ID: I20231128003518 |
| Provider Name | Victoria Postlewait |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922530088 PECOS PAC ID: 8921456955 Enrollment ID: I20231130002674 |
| Provider Name | Melissa Anne Bowling |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023597440 PECOS PAC ID: 4082062823 Enrollment ID: I20231204003713 |
| Provider Name | Katie Palmquist |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952767642 PECOS PAC ID: 2365891991 Enrollment ID: I20231208000033 |
| Provider Name | Shampa Davie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801921457 PECOS PAC ID: 8224480751 Enrollment ID: I20240119001607 |
| Provider Name | Diane L Schicker |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1437495413 PECOS PAC ID: 0244683787 Enrollment ID: I20240131002429 |
| Provider Name | Rhonda Yousef |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336911239 PECOS PAC ID: 4789029307 Enrollment ID: I20240305001360 |
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