Kenyatta Dacres

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11012249 Issued in FL

Practice address

4510 Rainer Rd
Jacksonville, FL 32210-7058

Phone

(904) 535-1977

NPI assigned

Apr 16, 2021

Last updated

Apr 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Institute of Pain Medicine LLCGroup PAC ID 4385769686, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent's Southside Hospital, Jacksonville, FL, CCN 100307
• Ascension St Vincent's Riverside Hospital, Jacksonville, FL, CCN 100040
• Ascension St Vincent's St Johns County Hospital, St. Johns, FL, CCN 100361

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Florida Institute of Pain Medicine LLC

  dba Florida Pain Physicians

  • Interventional Pain Medicine Physician
  • Jacksonville, FL
  • NPI 1194056283
  Medicare reassignment Care Compare group NPD
• Florida Psychiatry and Wellness, PLLC

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1356200711
  Medicare reassignment NPD
• SHC Medical Partners of Florida, LLC

  dba Abode Care Partners

  • Nurse Practitioner
  • Pensacola, FL
  • NPI 1861677064
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  FL

  Medicare reassignment
• Florida Institute of Pain Medicine LLC

  dba Florida Pain Physicians

  • Interventional Pain Medicine Physician
  • Palm Coast, FL
  • NPI 1144913666
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Lukes - St Vincents Healthcare

  dba Ascension St. Vincent's Southside

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1396926747
  Care Compare affiliation
• St Vincents Health System Inc

  dba Ascension St Vincent's St. Johns County

  • General Acute Care Hospital
  • Saint Johns, FL
  • NPI 1861078651
  Care Compare affiliation
• St Vincents Medical Center Inc

  dba Ascension St. Vincent's Riverside

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1134117575
  Care Compare affiliation
• St. Vincent's Medical Center, Inc.

  dba Ascension St Vincent's Riverside

  • Clinical Medical Laboratory
  • Jacksonville, FL
  • NPI 1669556072

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1356922850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 RAINER RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107058",
            "telephone_number": "904-535-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 RAINER RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107058",
            "telephone_number": "904-535-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACRES",
        "first_name": "KENYATTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11012249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jood Dabbas, MD
• Lindsey Dabbs
• Meseret Tilahun Dabi, PHARMD
• Nancy Katia Dachoute
• Monet Jeniece Dacius, APRN
• Oluwaferanmi Toluwanimi Dada, MD
• Artem Feliksovich Dadamyan
• Dade Medical, Inc. (Integrated Home Care)
• Melyssa Daege
• Chloe Daehne, M.S., CCC-SLP

• Family Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.