Healthcare Provider Details

I. General information

NPI: 1689393100
Provider Name (Legal Business Name): FAMH FOR ALL MENTAL HEALTH PSYCHIATRIC TELEMEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BISCAYNE BLVD STE 203
MIAMI FL
33137-3255
US

IV. Provider business mailing address

4300 BISCAYNE BLVD STE 203
MIAMI FL
33137-3255
US

V. Phone/Fax

Practice location:
  • Phone: 877-400-0540
  • Fax:
Mailing address:
  • Phone: 877-400-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIRK D NANKIVELL
Title or Position: CTO
Credential:
Phone: 877-400-0540