Individual provider Active NPI

Keonia Petrena Nembhard, AGPCNP

  • Primary Care Nurse Practitioner
  • West Palm Beach, FL
National Provider Identifier
1639046378
Registry record updated Oct 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APRN11042898 Issued in FL
Practice address
6118 Whalton St
West Palm Beach, FL 33411-6496
Phone
(207) 631-1610
Fax
(207) 631-1610
NPI assigned
Oct 18, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X APRN11042898 FL Primary

Addresses

Primary practice location

6118 Whalton St
West Palm Beach, FL 33411-6496

Mailing address

6118 Whalton St
West Palm Beach, FL 33411-6496
Phone (207) 631-1610

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
I20260121002151 FL Order and Referring Only - Nurse Practitioner 1254818222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN11042898FLMDPrimary Care Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1760745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760745600000",
    "number": "1639046378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6118 WHALTON ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334116496",
            "telephone_number": "207-631-1610",
            "fax_number": "207-631-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6118 WHALTON ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334116496",
            "telephone_number": "207-631-1610",
            "fax_number": "207-631-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEMBHARD",
        "first_name": "KEONIA",
        "middle_name": "PETRENA",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-18",
        "last_updated": "2025-10-18",
        "certification_date": "2025-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11042898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.