KIM FREDRICKS PMHNP-BC NPI 1104749068

NPI Information

  • NPI: 1104749068
  • Provider Name: KIM FREDRICKS, PMHNP-BC
  • Classification: Psychiatry & Neurology - 2084B0040X
  • Specialization: Behavioral Neurology & Neuropsychiatry
  • Entity Type: Individual
  • Address: 1200 W GRANADA BLVD STE 4
    ORMOND BEACH, FL
    ZIP 32174
  • Phone: (386) 983-4147

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NPI Details

Kim Fredricks, PMHNP-BC is a behavioral neurology and neuropsychiatry psychiatry neurology in Ormond Beach, FL. The provider is behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues. Kim Fredricks, PMHNP-BC NPI is 1104749068. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1200 W GRANADA BLVD STE 4
ORMOND BEACH, FL
ZIP 32174-157
Phone: (386) 983-4147

The enumeration date for this NPI number is 7/30/2026 and was last updated on 7/30/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0005XPsychiatry & NeurologyNeurodevelopmental DisabilitiesRN9508898FLORIDANo
22084P0800XPsychiatry & NeurologyPsychiatryRN9508898FLORIDANo
32084P0802XPsychiatry & NeurologyAddiction PsychiatryRN9508898FLORIDANo
42084P0805XPsychiatry & NeurologyGeriatric PsychiatryRN9508898FLORIDANo
52084B0040XPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryRN9508898FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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