| Ponte Vedra Neuropsychology Llc | |
|
4210 Valley Ridge Blvd Ste 113 Ponte Vedra FL 32081-5171 | |
| (904) 303-8362 | |
| Not Available |
| Full Name | Ponte Vedra Neuropsychology Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 4210 Valley Ridge Blvd Ste 113, Ponte Vedra, Florida |
| Authorized Official Name and Position | Kari Eng (CEO) |
| Authorized Official Contact | 9043038362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponte Vedra Neuropsychology Llc 176 Parkbluff Cir Ponte Vedra FL 32081-0958 Ph: (904) 303-8362 | Ponte Vedra Neuropsychology Llc 4210 Valley Ridge Blvd Ste 113 Ponte Vedra FL 32081-5171 Ph: (904) 303-8362 |
| NPI Number | 1114624277 |
|---|---|
| Provider Enumeration Date | 02/09/2023 |
| Last Update Date | 02/09/2023 |
| Certification Date | 02/09/2023 |
| Medicare PECOS PAC ID | 8628441292 |
|---|---|
| Medicare Enrollment ID | O20230301001241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114624277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Kari Ann Eng |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356591366 PECOS PAC ID: 1951699784 Enrollment ID: I20161011002998 |
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