Provider Demographics
NPI:1073193868
Name:DENNIS-COWART, KENYA (APRN)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:DENNIS-COWART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11799 JAYLIN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1642
Mailing Address - Country:US
Mailing Address - Phone:706-945-9670
Mailing Address - Fax:
Practice Address - Street 1:515 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4324
Practice Address - Country:US
Practice Address - Phone:904-253-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily