=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326456708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELEN KELLY SAYRE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 07/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5190 BAYOU BLVD STE 6
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-0977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5190 BAYOU BLVD STE 6
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-476-0977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LISA WEEKLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-587-3554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | MH12207
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------