Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

KIM FREDRICKS PMHNP-BC
NPI 1104749068
Nurse Practitioner - Psychiatric/Mental Health in Ormond Beach, FL

Q: 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.

Q: What is Kim Fredricks's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Kim Fredricks was last updated on October 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.

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: October 21, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 17, 2026, Jul 30, 2026 (2 updates tracked since 2026).

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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 psychiatric/mental health provider in Ormond Beach, Florida, licensed in Florida (11049791) and active in the NPI registry since July 2026.

NPPES Registry Identity

NPI1104749068

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

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

Last NPPES UpdateOctober 21, 20262 updates tracked since enumeration

NPPES CertifiedOctober 21, 2026

✔ NPI 1104749068 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in FL · 11049791

1200 W GRANADA BLVD STE 4, Ormond Beach, FL 32174

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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 Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Kim Fredricks was last updated on October 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.