NPIMap

Organization Active NPI

Psychiatric Associates. P.a.

  • Psychiatry Physician
  • Orange Park, FL
National Provider Identifier
1255740767
Registry record updated Aug 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PSYCHIATRIC ASSOCIATES. P.A.
Practice address
1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570
Phone
(904) 264-6977
Fax
(904) 269-0870
NPI assigned
Aug 8, 2014
Last updated
Aug 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2014

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

Authorized official

Name
Lanah W Larson, RNNPI 1740294958
Title
Secretary, Practice Administrator
Phone
(904) 264-6977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X FL Primary

Addresses

Primary practice location

1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570

Mailing address

1543 Kingsley Ave Ste 14
Orange Park, FL 32073-4570
Phone (904) 264-6977

Other identifiers 1

IdentifierTypeStateIssuer
25939900MedicaidFL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407456000000",
    "number": "1255740767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE STE 14",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734570",
            "telephone_number": "904-264-6977",
            "fax_number": "904-269-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 KINGSLEY AVE STE 14",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734570",
            "telephone_number": "904-264-6977",
            "fax_number": "904-269-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC ASSOCIATES. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-08",
        "last_updated": "2014-08-08",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "LANAH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SECRETARY, PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-264-6977",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25939900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; 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.