Provider Demographics
NPI:1528674603
Name:ATWELL, KEVIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ATWELL
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 TOWN VILLAGE BLVD APT 2303
Mailing Address - Street 2:
Mailing Address - City:MEXICO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32456-7212
Mailing Address - Country:US
Mailing Address - Phone:855-209-3255
Mailing Address - Fax:
Practice Address - Street 1:4243 SUNBEAM RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8975
Practice Address - Country:US
Practice Address - Phone:855-209-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018552363LP0808X
OHAPRN.CNP.0027591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health