Individual provider Active NPI

Kenya Leyva, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1265145932
Registry record updated Jan 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11023704 Issued in FL
Practice address
2624 Atlantic Blvd
Jacksonville, FL 32207-3609
Phone
(904) 513-3240
Fax
(904) 398-7871
NPI assigned
Dec 27, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11023704 FL Primary

Addresses

Primary practice location

2624 Atlantic Blvd
Jacksonville, FL 32207-3609

Mailing address

13990 Bartram Park Blvd Unit 2107
Jacksonville, FL 32258-5573
Phone (786) 302-9296

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240129001541 FL Practitioner - Nurse Practitioner 0648623447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emed Urgent and Primary Care IncGroup PAC ID 9830381664, 5 clinicians

Practice addresses (Care Compare)

2624 Atlantic Blvd
Suite 1
Jacksonville, FL 32207-3633
Phone (904) 513-3240

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11023704FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Omega Health and Nutrition LLC CurrentSince Jan 15, 2024 Accepting new patients

Locations

2624 Atlantic Blvd
Ste 1
Jacksonville, FL 32207
Phone (904) 413-3360

2624 Atlantic Blvd
Ste 6
Jacksonville, FL 32207
Phone (904) 513-3240

2624 Atlantic Blvd
Jacksonville, FL 32207
Phone (904) 513-3240

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1672099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1265145932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13990 BARTRAM PARK BLVD UNIT 2107",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585573",
            "telephone_number": "786-302-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073609",
            "telephone_number": "904-513-3240",
            "fax_number": "904-398-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEYVA",
        "first_name": "KENYA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-27",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11023704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.