Provider Demographics
NPI:1902435589
Name:KAIROS PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:KAIROS PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAULEK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWMGING
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:206-486-0424
Mailing Address - Street 1:10950 SAN JOSE BLVD # 60-213
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6688
Mailing Address - Country:US
Mailing Address - Phone:352-339-8013
Mailing Address - Fax:
Practice Address - Street 1:4105 CROWNWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3610
Practice Address - Country:US
Practice Address - Phone:206-486-0424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-05
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty