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NPI Code Detail

MEDICARE: MS. KENOVIAH HERON DO

MEDICARE: MS. KENOVIAH HERON DO
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS20305FL

General Provider Information

NPI Number : 1740809433
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KENOVIAH HERON DO
Provider Business Mailing Address
First Line : 1839 CENTRAL AVE
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33713-9089
Country : US
Telephone Number : 727-322-1054
Fax Number :
Provider Business Practice Location Address
First Line : 1839 CENTRAL AVE
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33713-9089
Country : US
Telephone Number : 727-322-1054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2020
Last Update Date : 05/22/2026

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Directions to “ MS. KENOVIAH HERON DO” Practice Location

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