Healthcare Provider Details

I. General information

NPI: 1659293181
Provider Name (Legal Business Name): KENEISHA THOMPSON-WATSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 VAN GUNDY RD
JACKSONVILLE FL
32208-2583
US

IV. Provider business mailing address

2420 VAN GUNDY RD
JACKSONVILLE FL
32208-2583
US

V. Phone/Fax

Practice location:
  • Phone: 904-600-2883
  • Fax:
Mailing address:
  • Phone: 904-600-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA297585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: