JOURNEYPURE FORT WALTON (NPI# 1528454352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528454352 |
| Entity Type | Organization |
| Organization Name | JOURNEYPURE FORT WALTON |
| Practice Address |
907 Mar Walt Dr Suite 2013 Fort Walton Beach FL 32547-6960 |
| Mailing Address |
115 Penn Warren Dr Suite 300-290 Brentwood TN 37027-5047 |
| Practice Telephone | 8502494300 |
| Mailing Telephone | 6157278386 |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2015-04-08 |
| Authorized Official Name | PATRICK DUNN (VICE PRESIDENT) |
| Authorized Official Telephone | 5024723728 |
| Authorized Official Credential | MS ICADC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
0146AD9349-01 | FL | Ambulatory Health Care Facilities |
| Street Address |
907 MAR WALT DR SUITE 2013 |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6960 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962463885 | Penelope Linda Carter | Nurse Practitioner | 907 Mar Walt Dr, Fort Walton Beach, FL 32547-6960 | 2006-03-30 |
| 1205264900 | Guillot Enterprises, LLC | Clinic/Center | 907 Mar Walt Dr, Suite 2012, Fort Walton Beach, FL 32547-6960 | 2013-10-16 |
| 1447403134 | Michael H. Hennessey, Md, Pa | Obstetrics & Gynecology | 907 Mar Walt Dr, Suite 2024, Fort Walton Beach, FL 32547-6960 | 2008-10-28 |
| 1134371271 | Kelsie Leeanne Yang | Physician Assistant | 907 Mar Walt Dr, Suite 2024, Fort Walton Beach, FL 32547-6960 | 2008-10-21 |
| 1245417963 | Digitrace Care Services | Durable Medical Equipment & Medical Supplies | 907 Mar Walt Dr, Suite 2021, Fort Walton Beach, FL 32547-6960 | 2008-01-24 |
| 1265655922 | In Your Dreams International Inc | Durable Medical Equipment & Medical Supplies | 907 Mar Walt Dr, Suite 2021, Fort Walton Beach, FL 32547 | 2007-04-11 |
| 1902950108 | Michael Alan Archer | Specialist | 907 Mar Walt Dr, Suite 2012, Fort Walton Beach, FL 32547-6960 | 2007-01-23 |
| 1477587111 | In Your Dreams International Inc | Psychiatry & Neurology | 907 Mar Walt Dr, Suite 2021, Fort Walton Beach, FL 32547 | 2006-07-10 |
| 1396779070 | Sleepmed Therapies Inc. | Durable Medical Equipment & Medical Supplies | 907 Mar Walt Dr, Suite 2022, Fort Walton Beach, FL 32547 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437384518 | Phoenixco. | Clinic/Center | 348 Miracle Strip Pkwy Sw Ste 13, Fort Walton Beach, FL 32548-5258 | 2009-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839283 | St John's Recovery Place LLC | Clinic/Center | St Johns Recovery Place LLC, 1811 S Orlando Ave, Cocoa Beach, FL 32931-3211 | 2020-07-24 |
| 1205451689 | Inspire of Palm Beach | Clinic/Center | 1803 S Australian Ave, West Palm Beach, FL 33409-6454 | 2020-06-11 |
| 1548882319 | Melrose Institute, LLC | Clinic/Center | 450 W Hillsboro Bvd, Deerfield Bch, FL 33441 | 2020-05-14 |
| 1265054761 | Holistix Treatment Centers, LLC | Clinic/Center | 5311 Lake Worth Rd, Greenacres, FL 33463-3353 | 2020-05-07 |
| 1558908517 | Caring Hands Wellness Center, Inc | Clinic/Center | 3601 W Commercial Blvd Ste 22, Fort Lauderdale, FL 33309-3320 | 2019-12-09 |
| 1750937041 | The Process Treatment Center, LLC | Clinic/Center | 521 Northlake Blvd Ste 1, North Palm Beach, FL 33408-5418 | 2019-08-13 |
| 1083275804 | Jayson Williams Center Inc. | Clinic/Center | 5499 N Federal Hwy Ste Gandl2, Boca Raton, FL 33487-4993 | 2019-06-24 |
| 1053970053 | Alternatives for You, LLC | Clinic/Center | 8895 N Military Trl Ste 101e, West Palm Beach, FL 33410-6262 | 2019-06-12 |
| 1700443520 | American Detox and Wellness Center | Clinic/Center | 12150 Cortez Blvd, Brooksville, FL 34613-5575 | 2019-05-28 |
| 1982268058 | M.a.t. of The Palm Beaches LLC | Clinic/Center | 321 Northlake Blvd Ste 116, North Palm Beach, FL 33408-5410 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.