Provider Demographics
NPI:1295179661
Name:PARKER, KENNETH W SR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:PARKER
Suffix:SR
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 1:1783 LAKENOLL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5115
Mailing Address - Country:US
Mailing Address - Phone:513-295-5573
Mailing Address - Fax:
Practice Address - Street 1:1783 LAKENOLL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5115
Practice Address - Country:US
Practice Address - Phone:513-295-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4008022071008376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide