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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 30 days.

KIM FREDRICKS PMHNP-BC
NPI 1104749068
Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry in Ormond Beach, FL

Active since July 30, 2026
1200 W GRANADA BLVD STE 4, ORMOND BEACH, FL 32174(386) 983-4147 Get Directions Write a Review

NPPES record added: July 30, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kim Fredricks Pmhnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIM FREDRICKS PMHNP-BC (NPI 1104749068) is an individual behavioral neurology & neuropsychiatry provider in Ormond Beach, Florida, licensed in Florida (RN9508898) and active in the NPI registry since July 2026.

NPPES Registry Identity

NPI1104749068
Entity TypeIndividualFemale
Primary Taxonomy2084B0040X
Provider Legal NameKIM FREDRICKSCredential: PMHNP-BC
Location Address1200 W GRANADA BLVD STE 4Ormond Beach, FL 32174-8157
Mailing Address1200 W Granada Blvd Ste 4Ormond Beach, FL 32174-8157
Phone(386) 983-4147
Sole ProprietorYes
Enumeration DateJuly 30, 2026
NPPES CertifiedJuly 30, 2026
✔ NPI 1104749068 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyPsychiatry & Neurology · Behavioral Neurology & NeuropsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084B0040X
License✔ Licensed in FL · RN9508898
Definition
Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
Also ListedPsychiatry & Neurology · Neurodevelopmental DisabilitiesTaxonomy 2084P0005X · License RN9508898 (FL)
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License RN9508898 (FL)
Also ListedPsychiatry & Neurology · Addiction PsychiatryTaxonomy 2084P0802X · License RN9508898 (FL)
Also ListedPsychiatry & Neurology · Geriatric PsychiatryTaxonomy 2084P0805X · License RN9508898 (FL)
1200 W GRANADA BLVD STE 4, Ormond Beach, FL 32174
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HALIFAX HEALTH SERVICES, LLC.
Home Health
1200 W GRANADA BLVD STE 4
ORMOND BEACH, FL 32174
Flagler County (386) 872-4700
HALIFAX HEALTH SERVICES LLC
Home Health
1200 W GRANADA BLVD STE 4
ORMOND BEACH, FL 32174
Flagler County (386) 872-4700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kim Fredricks's NPI number?

The NPI number for Kim Fredricks is 1104749068. It was assigned to this individual provider in the NPPES registry on July 30, 2026.

Where is Kim Fredricks located?

Kim Fredricks practices at 1200 W Granada Blvd Ste 4, Ormond Beach, FL 32174. The listed phone number is (386) 983-4147.

What is Kim Fredricks's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Behavioral Neurology & Neuropsychiatry, with taxonomy code 2084B0040X.

When was this NPI record last updated?

The NPPES record for Kim Fredricks was last updated on July 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.