Prestige Senior Care

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

PRESTIGE SENIOR CARE

Practice address

10151 Deerwood Park Blvd Ste 250
Jacksonville, FL 32256-0566

Phone

(800) 438-6702

NPI assigned

Apr 11, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Mix, MDNPI 1154907897

Title

Owner

Phone

(904) 545-5481

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prestige Senior Care Former legal business name

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Mix

  • Home Health Aide
  • Jacksonville, FL
  • NPI 1154907897
  NPD Authorized official

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

{
    "created_epoch": "1618099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618099200000",
    "number": "1275113565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8450 GATE PKWY W UNIT 1330",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161072",
            "telephone_number": "904-545-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 DEERWOOD PARK BLVD STE 250",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560566",
            "telephone_number": "800-438-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE SENIOR CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-11",
        "last_updated": "2021-04-11",
        "certification_date": "2021-04-11",
        "status": "A",
        "authorized_official_last_name": "MIX",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-545-5481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTH AIDE",
            "identifier": "1154907897",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.prestigeseniorcare.com",
            "affiliation": "N",
            "address_1": "10151 Deerwood Park Blvd Ste 250",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322560566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prestige Senior Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Prestige Quality Care Services, LLC
• Prestigerx Pharmacy LLC
• Preston H. Starks Family Eyecare LLC
• Jowana T'Pring Preston-Gray
• Asia D Preston
• Dana Yvonne Preston, PHD, APRN, - C.S

• Clinical Child & Adolescent Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2021; 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.