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General NPI Number Information
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NPI Number | 1790472678
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Entity Type | Organization
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Legal Business Name | KEY WEST HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 1111 12TH ST STE 205
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City | KEY WEST
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State | FL
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Zip | 33040-3001
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Country | US
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Telephone | 615-465-7211
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Fax | 615-628-6877
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Provider Business Mailing Address
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Address Line | 1111 12TH ST STE 205
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City | KEY WEST
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State | FL
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Zip | 33040-3001
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Country | US
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Telephone | 615-465-7211
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Fax | 615-628-6877
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Authorized Official
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Title or Position | SR DR PROV ENROLLMENT & ONBOARDING
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Name | JENNIFER L JACKSON
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Credential |
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Telephone | 615-465-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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