Provider Demographics
NPI:1275144420
Name:MARKS, KENNETH CARTER
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CARTER
Last Name:MARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:ANSTED
Mailing Address - State:WV
Mailing Address - Zip Code:25812-0724
Mailing Address - Country:US
Mailing Address - Phone:304-719-9572
Mailing Address - Fax:
Practice Address - Street 1:27 HALSTEAD STREET
Practice Address - Street 2:B
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812
Practice Address - Country:US
Practice Address - Phone:304-719-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide