Provider Demographics
NPI:1861151136
Name:WILCOX, KENYANNYA
Entity type:Individual
Prefix:MS
First Name:KENYANNYA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 VALLEY CROSSING DR.
Mailing Address - Street 2:ADDRESS 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2582
Mailing Address - Country:US
Mailing Address - Phone:904-401-1308
Mailing Address - Fax:
Practice Address - Street 1:2007 VALLEY CROSSING DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2582
Practice Address - Country:US
Practice Address - Phone:904-401-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No174H00000XOther Service ProvidersHealth Educator