Kennyanna Jefferson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

127688 Issued in CA

Practice address

17053 Foothill Blvd
Fontana, CA 92335-3574

Phone

(909) 347-1300

Fax

(909) 347-1302

NPI assigned

May 20, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kennyanna.jefferson.p1@direct.chsica.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bloomington, CA
  • NPI 1952308009
  Medicare reassignment NPD
• Indiana University Health Ball Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Muncie, IN
  • NPI 1225195340
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1114540598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E FOOTHILL BLVD",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923765230",
            "telephone_number": "909-420-9472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17053 FOOTHILL BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353574",
            "telephone_number": "909-347-1300",
            "fax_number": "909-347-1302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "850 E Foothill Blvd",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923765230",
            "country_code": "US",
            "telephone_number": "909-420-9472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "KENNYANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-20",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "102016",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW102016",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "127688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rommel Javier
• Kumari Maya Jayawardena, MD
• JD Med Transportation LLC
• Emanuel Jean-Pierre, PA-C
• Jefferson and Chokka Dental Corporation
• Faisal S. Jehan, MD
• Marie T. Jelonek, MD
• Denise Jen
• Cathy E Jenkins-Etter, OTR
• Carla Jenkins-Skelton

• Clinical Social Worker in Fontana, CA
• Providers in Fontana, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.