NPIMap

Organization Active NPI

Coastline Neuropsychiatric

  • Clinical Neuropsychologist
  • Pensacola, FL
National Provider Identifier
1043996986
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
COASTLINE NEUROPSYCHIATRIC
Practice address
890 S Palafox St Suite 300-L
Pensacola, FL 32502
Phone
(850) 341-4896
Fax
(850) 433-1996
NPI assigned
Jun 26, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin Neil Groom, PH.D.
Title
Owner
Phone
(850) 341-4896

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X Primary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

890 S Palafox St Suite 300-L
Pensacola, FL 32502

Mailing address

304 W Gadsden St
Pensacola, FL 32501
Phone (850) 341-4896

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1043996986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W GADSDEN ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32501",
            "telephone_number": "850-341-4896",
            "fax_number": "850-433-1996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 S PALAFOX ST SUITE 300-L",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32502",
            "telephone_number": "850-341-4896",
            "fax_number": "850-433-1996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE NEUROPSYCHIATRIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "GROOM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-341-4896",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.