Provider Demographics
NPI:1174407696
Name:PRIME PSYCHIATRY AND WELLNESS PLLC
Entity type:Organization
Organization Name:PRIME PSYCHIATRY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:JENISE
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:AUTONOMOUS APRN
Authorized Official - Phone:850-377-2769
Mailing Address - Street 1:5958 CHERRY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9211
Mailing Address - Country:US
Mailing Address - Phone:850-377-2769
Mailing Address - Fax:
Practice Address - Street 1:4519 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8706
Practice Address - Country:US
Practice Address - Phone:850-806-1668
Practice Address - Fax:850-806-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty