Provider Demographics
NPI:1275248304
Name:HAIR BY KENNY SALON
Entity Type:Organization
Organization Name:HAIR BY KENNY SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-452-3837
Mailing Address - Street 1:7643-27 PINEVILLE-MATTHEWS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:904-452-3837
Mailing Address - Fax:
Practice Address - Street 1:7643-27 PINEVILLE-MATTHEWS RD
Practice Address - Street 2:STE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:904-452-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty