Provider Demographics
NPI:1053313577
Name:SLONE, KENNETH MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MORRIS
Last Name:SLONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COWTOWN RD.,
Mailing Address - Street 2:UK JUNE BUCHANAN CLINIC
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822
Mailing Address - Country:US
Mailing Address - Phone:606-785-3175
Mailing Address - Fax:606-785-9968
Practice Address - Street 1:59 COWTOWN RD.,
Practice Address - Street 2:UK JUNE BUCHANAN CLINIC
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-3175
Practice Address - Fax:606-785-9968
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64241227Medicaid
KY64241227Medicaid
KYC65511Medicare UPIN