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General NPI Number Information
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NPI Number | 1861299745
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Entity Type | Organization
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Legal Business Name | HUMAN ROOTS INTEGRATIVE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 425 TOWN PLAZA AVE
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City | PONTE VEDRA
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State | FL
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Zip | 32081
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Country | US
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Telephone | 877-595-7668
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Fax | 877-595-7570
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Provider Business Mailing Address
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Address Line | 425 TOWN PLAZA AVE
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City | PONTE VEDRA
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State | FL
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Zip | 32081
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Country | US
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Telephone | 877-595-7668
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Fax | 877-595-7570
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | ANNELINE KINGSLEY
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Credential | MD
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Telephone | 877-595-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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