Coastline Mental Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

COASTLINE MENTAL HEALTH LLC

Practice address

1723 Pine Ave
Niceville, FL 32578-4600

Phone

(850) 368-4670

NPI assigned

Aug 15, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Brian Wade Pullam, APRN, FNP-C, PMHNP-BNPI 1770121535

Title

Owner

Phone

(850) 368-4670

Specialties & licenses 1

Addresses

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.

• Brian Wade Pullam

  • Psychiatric/Mental Health Nurse Practitioner
  • Niceville, FL
  • NPI 1770121535
  NPD Authorized official

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

{
    "created_epoch": "1723680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1811729015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 PINE AVE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325784600",
            "telephone_number": "850-368-4670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 PINE AVE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325784600",
            "telephone_number": "850-368-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-15",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "PULLAM",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-368-4670",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN, FNP-C, PMHNP-B"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Lester Clark, MD
• Christopher Craig Clevenger, PHARMD
• Coastal Anesthesia, P a
• Coastal Orthopedic
• Coastal Vascular and Interventional PLLC
• Ashley Coker
• Janice Marie Collier, L.M.H.C.
• Comfortable Care Denta Health Professionals, PA (Okaloosa Family Dental)
• Kelly Conlan, BCBA
• Patrick F Conrad, MD

• Psychiatric/Mental Health Nurse Practitioner in Niceville, FL
• Providers in Niceville, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.