| Totally Psyched, Llc | |
|
1223 Daniels Rd Winter Garden FL 34787-3835 | |
| (689) 240-7945 | |
| (833) 973-2664 |
| Full Name | Totally Psyched, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1223 Daniels Rd, Winter Garden, Florida |
| Authorized Official Name and Position | Kristopher Stewart Oldham (OWNER) |
| Authorized Official Contact | 8176893369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Totally Psyched, Llc 15161 Newtonia St Winter Garden FL 34787-5647 Ph: (817) 689-3369 | Totally Psyched, Llc 1223 Daniels Rd Winter Garden FL 34787-3835 Ph: (689) 240-7945 |
| NPI Number | 1396479697 |
|---|---|
| Provider Enumeration Date | 07/12/2022 |
| Last Update Date | 05/02/2025 |
| Certification Date | 05/02/2025 |
| Medicare PECOS PAC ID | 7113301680 |
|---|---|
| Medicare Enrollment ID | O20220901000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396479697 | NPI | - | NPPES |
| Provider Name | Kristopher Stewart Oldham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619357787 PECOS PAC ID: 7315250248 Enrollment ID: I20161119000257 |
| Provider Name | Fabian Alexandro Consbruck |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740764158 PECOS PAC ID: 5193158095 Enrollment ID: I20191206002230 |
| Provider Name | Craig Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215789714 PECOS PAC ID: 9234579574 Enrollment ID: I20240502003502 |
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