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General NPI Number Information
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NPI Number | 1174407696
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Entity Type | Organization
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Legal Business Name | PRIME PSYCHIATRY AND WELLNESS PLLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 4519 WOODBINE RD
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City | PACE
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State | FL
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Zip | 32571-8706
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Country | US
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Telephone | 850-806-1668
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Fax | 850-806-1668
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Provider Business Mailing Address
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Address Line | 5958 CHERRY HILL CIR
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City | PACE
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State | FL
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Zip | 32571-9211
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Country | US
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Telephone | 850-377-2769
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Fax | 850-202-9917
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Authorized Official
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Title or Position | PMHNP-BC
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Name | KYLEE JENISE DALTON
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Credential | AUTONOMOUS APRN
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Telephone | 850-377-2769
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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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