Healthcare Provider Details

I. General information

NPI: 1174485882
Provider Name (Legal Business Name): JACQUELINE DIONE KENTON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 N ALAFAYA TRL
ORLANDO FL
32826-2940
US

IV. Provider business mailing address

3157 N ALAFAYA TRL
ORLANDO FL
32826-2940
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-1360
  • Fax:
Mailing address:
  • Phone: 407-986-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045609
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number188379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: