Healthcare Provider Details

I. General information

NPI: 1043607658
Provider Name (Legal Business Name): KENYA CANNONIER FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 MARKET ST
SAN FRANCISCO CA
94114-1612
US

IV. Provider business mailing address

27 HOLSTONE LN
WILLINGBORO NJ
08046-1817
US

V. Phone/Fax

Practice location:
  • Phone: 862-255-8112
  • Fax: 862-298-0816
Mailing address:
  • Phone: 862-255-8112
  • Fax: 862-298-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00564600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26NJ00564600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00564600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: