Provider Demographics
NPI:1770346363
Name:MINDREST PSYCHIATRY
Entity type:Organization
Organization Name:MINDREST PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PERCY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-C
Authorized Official - Phone:850-745-5111
Mailing Address - Street 1:778 CASON CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-6471
Mailing Address - Country:US
Mailing Address - Phone:850-745-5111
Mailing Address - Fax:850-745-5222
Practice Address - Street 1:26 W OAK AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2734
Practice Address - Country:US
Practice Address - Phone:850-745-5111
Practice Address - Fax:850-745-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty