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General NPI Number Information
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NPI Number | 1902435589
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Entity Type | Organization
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Legal Business Name | KAIROS PSYCHIATRY PLLC
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 4105 CROWNWOOD DR
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3610
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Country | US
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Telephone | 206-486-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 10950 SAN JOSE BLVD # 60-213
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City | JACKSONVILLE
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State | FL
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Zip | 32223-6688
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Country | US
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Telephone | 352-339-8013
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAULEK TAWMGING
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Credential | DNP
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Telephone | 206-486-0424
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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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