Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kim Fredricks, PMHNP-BC

Individual provider Neurodevelopmental Disabilities Physician · NPI 1104749068

Kim Fredricks, PMHNP-BC is a Neurodevelopmental Disabilities Physician in Ormond Beach, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2026
Specialties on file
5
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

See every abbreviation used in this directory →

Practice location Address checks out

1200 W Granada Blvd Ste 4
Ormond Beach, FL 32174-8157
Phone: (386) 983-4147
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavioral Neurology & Neuropsychiatry Physician (primary) Taxonomy 2084B0040X · Licence RN9508898 (FL)
Neurodevelopmental Disabilities Physician Taxonomy 2084P0005X · Licence RN9508898 (FL)
Psychiatry Physician Taxonomy 2084P0800X · Licence RN9508898 (FL)
Addiction Psychiatry Physician Taxonomy 2084P0802X · Licence RN9508898 (FL)
Geriatric Psychiatry Physician Taxonomy 2084P0805X · Licence RN9508898 (FL)

Record details

NPI number1104749068
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP-BC
Sole proprietorYes
NPI enumeratedJuly 30, 2026
Last updated in NPPESJuly 30, 2026
Certification dateJuly 30, 2026
Mailing address1200 W Granada Blvd Ste 4, Ormond Beach, FL 32174-8157