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General NPI Number Information
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NPI Number | 1780503516
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Entity Type | Organization
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Legal Business Name | XIII MOONS APOTHECARY & FUNCTIONAL WELLNESS CENTER
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 6050 MONCRIEF RD STE 8
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City | JACKSONVILLE
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State | FL
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Zip | 32209-2564
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Country | US
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Telephone | 904-551-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 MONCRIEF RD STE 8
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City | JACKSONVILLE
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State | FL
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Zip | 32209-2564
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Country | US
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Telephone | 904-551-0110
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | MRS. KENYA BONNER
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Credential |
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Telephone | 904-551-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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