Kim Fredricks, PMHNP-BC

Primary specialty

Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X

License

RN9508898 Issued in FL

Practice address

1200 W Granada Blvd Ste 4
Ormond Beach, FL 32174-8157

Phone

(386) 983-4147

NPI assigned

Jul 30, 2026

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1785369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1104749068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W GRANADA BLVD STE 4",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W GRANADA BLVD STE 4",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748157",
            "telephone_number": "386-983-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKS",
        "first_name": "KIM",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-30",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "FL",
            "license": "RN9508898",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "FL",
            "license": "RN9508898",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "FL",
            "license": "RN9508898",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "RN9508898",
            "primary": false
        },
        {
            "code": "2084P0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": "FL",
            "license": "RN9508898",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank a Broome Jr O.D.
• Manuel Frankel, DDS
• Natalie Elizabeth Franklin, L.M.T
• Virginia G Franks, CRNA
• Jayme Frear, DC
• Chara Free
• Christy Lynn Freed, WHNP-BC
• Nancy Milagros Freeman
• Ryan Freeman
• Francine Fremd

• Behavioral Neurology & Neuropsychiatry Physician in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Behavioral Neurology & Neuropsychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.