Healthcare Provider Details

I. General information

NPI: 1619789484
Provider Name (Legal Business Name): KENYA BONNER BCHHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 MONCRIEF RD STE 8
JACKSONVILLE FL
32209-2564
US

IV. Provider business mailing address

5018 TROUT RIVER BLVD
JACKSONVILLE FL
32208-1086
US

V. Phone/Fax

Practice location:
  • Phone: 904-631-4801
  • Fax:
Mailing address:
  • Phone: 904-631-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: