Provider Demographics
NPI:1902198658
Name:NEDA KOEHNEMANN PH D INC
Entity Type:Organization
Organization Name:NEDA KOEHNEMANN PH D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST CLINICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:850-522-9719
Mailing Address - Street 1:105 JAZZ DRIVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4906
Mailing Address - Country:US
Mailing Address - Phone:850-522-9719
Mailing Address - Fax:850-522-9718
Practice Address - Street 1:105 JAZZ DRIVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4906
Practice Address - Country:US
Practice Address - Phone:850-522-9719
Practice Address - Fax:850-522-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59895AMedicare PIN