Healthcare Provider Details

I. General information

NPI: 1215867239
Provider Name (Legal Business Name): KWABENA SENIOR PMHNP-BC, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 OLD DIXIE HWY
VERO BEACH FL
32960-3654
US

IV. Provider business mailing address

288 SE TODD AVE
PORT SAINT LUCIE FL
34983-3137
US

V. Phone/Fax

Practice location:
  • Phone: 772-584-3067
  • Fax: 877-300-2402
Mailing address:
  • Phone: 772-584-3067
  • Fax: 877-300-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11043571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: