Provider Demographics
NPI:1023009008
Name:VINING, KENNETH JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:VINING
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:NAVAL HOSPITAL BREMERTON
Mailing Address - Street 2:1 BOONE ROAD
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1898
Mailing Address - Country:US
Mailing Address - Phone:360-315-4346
Mailing Address - Fax:360-396-4247
Practice Address - Street 1:NAVAL HOSPITAL BREMERTON
Practice Address - Street 2:1 BOONE ROAD
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1898
Practice Address - Country:US
Practice Address - Phone:360-315-4346
Practice Address - Fax:360-396-4247
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical