Provider Demographics
NPI:1053510149
Name:KENNISON, LYNNETTE HANSEN (PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:HANSEN
Last Name:KENNISON
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHCNS-BC, PHD
Mailing Address - Street 1:9889 GATE PKWY N STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9230
Mailing Address - Country:US
Mailing Address - Phone:904-725-6463
Mailing Address - Fax:904-329-2349
Practice Address - Street 1:9889 GATE PKWY N STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9230
Practice Address - Country:US
Practice Address - Phone:904-725-6463
Practice Address - Fax:904-329-2349
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1117892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health