Provider Demographics
NPI:1346403516
Name:MCKENNON, BOBBIE J (RN)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:MCKENNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 AVENUE F NE
Mailing Address - Street 2:BEHAVIORAL HEALTH DIVISION
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-294-7062
Mailing Address - Fax:863-291-6755
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:BEHAVIORAL HEALTH DIVISION
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-294-7062
Practice Address - Fax:863-291-6755
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1750152163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse