Provider Demographics
NPI:1275763229
Name:HESS, KENNETH JARED (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JARED
Last Name:HESS
Suffix:
Gender:M
Credentials:DO
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 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-479-4224
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:320 STEELES RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-9532
Practice Address - Country:US
Practice Address - Phone:423-390-1900
Practice Address - Fax:423-390-1899
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202746207Q00000X
TN2400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I082178Medicare PIN
VAVV2420BMedicare PIN