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General NPI Number Information
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NPI Number | 1275389397
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Entity Type | Organization
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Legal Business Name | PREMIER PSYCHIATRIC AND PRIMARY HEALTHCARE
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 9305 OGLETHORPE DRIVE
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City | GROVELAND
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State | FL
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Zip | 34736
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Country | US
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Telephone | 407-987-3933
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Fax | 407-987-3933
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Provider Business Mailing Address
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Address Line | 2582 MAGUIRE RD STE 224
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City | OCOEE
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State | FL
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Zip | 34761-4749
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Country | US
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Telephone | 407-269-4935
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KELLY EILEEN JEAN-LOUIS
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Credential | NP
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Telephone | 407-987-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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