MEDICARE: MRS. KENYA BONNER BCHHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	175F00000X	Naturopath
2	175L00000X	Homeopath
3	374K00000X	Religious Nonmedical Practitioner
4	174H00000X	Health Educator	FL
5	171400000X	Health & Wellness Coach	FL
6	374J00000X	Doula	FL

General Provider Information

NPI Number	:	1619789484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENYA BONNER BCHHP

Provider Business Mailing Address
First Line	:	5018 TROUT RIVER BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-1086
Country	:	US
Telephone Number	:	904-631-4801
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 MONCRIEF RD STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-2564
Country	:	US
Telephone Number	:	904-631-4801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	12/08/2025

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