Provider Demographics
NPI:1295503654
Name:RURAL AND HEALTH DISPARITIES PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:RURAL AND HEALTH DISPARITIES PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:FLICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:609-477-3373
Mailing Address - Street 1:8063 BEATLE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8226
Mailing Address - Country:US
Mailing Address - Phone:609-477-3373
Mailing Address - Fax:
Practice Address - Street 1:8063 BEATLE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8226
Practice Address - Country:US
Practice Address - Phone:609-477-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty