Individual provider · Type 1 NPI
Kim Fredricks, PMHNP-BC
Psychiatric/Mental Health Nurse Practitioner · Ormond Beach, FL
NPI number
1104749068
Active
Practice location
1200 W Granada Blvd Ste 4
Ormond Beach, FL 32174-8157
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 11049791 (FL) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
2 other providers at this address
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About NPI 1104749068
Kim Fredricks, PMHNP-BC's National Provider Identifier is 1104749068, issued on Jul 30, 2026. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Ormond Beach, FL. The record was last updated on Oct 21, 2026.