Provider Demographics
NPI:1093020984
Name:BEMIS, KENNETH (CS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BEMIS
Suffix:
Gender:M
Credentials:CS
Other - Prefix:
Other - First Name:KEB
Other - Middle Name:
Other - Last Name:BEMIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13259 PINETREE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5923
Mailing Address - Country:US
Mailing Address - Phone:503-740-4805
Mailing Address - Fax:
Practice Address - Street 1:714 TIGER LILY WAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5710
Practice Address - Country:US
Practice Address - Phone:303-578-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner