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General NPI Number Information
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NPI Number | 1174367825
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Entity Type | Organization
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Legal Business Name | TWIN RIVERS MENTAL HEALTH
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 215 HOWARD ST W
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City | LIVE OAK
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State | FL
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Zip | 32064-2303
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Country | US
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Telephone | 386-319-0709
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Fax | 855-616-8455
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Provider Business Mailing Address
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Address Line | 215 HOWARD ST W
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City | LIVE OAK
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State | FL
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Zip | 32064-2303
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Country | US
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Telephone | 386-319-0709
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Fax | 855-616-8455
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLEI FALLER
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Credential | PMHNP-BC, FNP-BC
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Telephone | 386-319-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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