Active NPI
Kenisha Otaris
- Health Educator
- Port Saint Lucie, FL
National Provider Identifier
1659254548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- W790355
- Practice address
- 2343 SW Mountwell St
Port Saint Lucie, FL 34984-5055 - Phone
- (728) 500-9585
- NPI assigned
- Jul 28, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | W790355 | FL | Primary |
Addresses
Primary practice location
2343 SW Mountwell St
Port Saint Lucie, FL 34984-5055
Mailing address
2343 SW Mountwell St
Port Saint Lucie, FL 34984-5055
Phone (728) 500-9585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| W790355 | FL | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753660800000",
"number": "1659254548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2343 SW MOUNTWELL ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349845055",
"telephone_number": "728-500-9585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2343 SW MOUNTWELL ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349845055",
"telephone_number": "728-500-9585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTARIS",
"first_name": "KENISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-28",
"last_updated": "2025-07-28",
"certification_date": "2025-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "FL",
"license": "W790355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.