Provider Demographics
NPI:1316546922
Name:HAMMER, KENNY A
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:A
Last Name:HAMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:A
Other - Last Name:HAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3807 22ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-2439
Mailing Address - Country:US
Mailing Address - Phone:701-570-6297
Mailing Address - Fax:
Practice Address - Street 1:3807 22ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-2439
Practice Address - Country:US
Practice Address - Phone:701-570-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant