Healthcare Provider Details

I. General information

NPI: 1134043847
Provider Name (Legal Business Name): KENCARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/23/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N WESTMONTE DR 1ST & 2ND FLOOR 17590791
ALTAMONTE SPRINGS FL
32714-3345
US

IV. Provider business mailing address

813 LINDSEY PL
LAKE WALES FL
33853-3576
US

V. Phone/Fax

Practice location:
  • Phone: 863-348-0997
  • Fax: 863-474-0777
Mailing address:
  • Phone: 863-348-0997
  • Fax: 863-474-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FELICIA THOMAS
Title or Position: OWNER
Credential: APRN
Phone: 863-348-0997