Healthcare Provider Details

I. General information

NPI: 1891061545
Provider Name (Legal Business Name): KELSEY M LATIMER PHD, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SE OCEAN BLVD
STUART FL
34994-2214
US

IV. Provider business mailing address

1 SE OCEAN BLVD
STUART FL
34994-2214
US

V. Phone/Fax

Practice location:
  • Phone: 561-264-2329
  • Fax:
Mailing address:
  • Phone: 561-264-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35191
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11038673
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY9652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: