Provider Demographics
NPI:1912159666
Name:WATKINS-BROWN, KENA RUTH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KENA
Middle Name:RUTH
Last Name:WATKINS-BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 LORD NELSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6749
Mailing Address - Country:US
Mailing Address - Phone:904-707-0533
Mailing Address - Fax:
Practice Address - Street 1:866 LORD NELSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6749
Practice Address - Country:US
Practice Address - Phone:904-707-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2614052363LA2200X
FL2614052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health