KENNETH EZENWA RN NPI 1003379959

NPI Information

  • NPI: 1003379959
  • Provider Name: KENNETH EZENWA, RN
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 17467 HONEY MAPLE ST
    CANYON COUNTRY, CA
    ZIP 91387
  • Phone: (661) 212-5273

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NPI Details

Kenneth Ezenwa, RN is a psychiatric/mental health nurse practitioner in Canyon Country, CA with 6 years of experience. Kenneth Ezenwa, RN NPI is 1003379959. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

17467 HONEY MAPLE ST
CANYON COUNTRY, CA
ZIP 91387-870
Phone: (661) 212-5273

The NPI 1003379959 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/8/2019 and was last updated on 2/8/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163WP0808XRegistered NursePsychiatric/Mental Health95080178CALIFORNIANo
2363LP0808XNurse PractitionerPsychiatric/Mental Health95080178CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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