Healthcare Provider Details

I. General information

NPI: 1013779008
Provider Name (Legal Business Name): BARBARA C KENERSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 CERULEAN AVE
GARDEN GROVE CA
92845-2709
US

IV. Provider business mailing address

453 S SPRING ST STE 400
LOS ANGELES CA
90013-2074
US

V. Phone/Fax

Practice location:
  • Phone: 714-943-3126
  • Fax:
Mailing address:
  • Phone: 818-570-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: