Provider Demographics
NPI:1346459252
Name:MORRIS, KENNETH BRIAN
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRIAN
Last Name:MORRIS
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 1:4125 NE AINSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7940
Mailing Address - Country:US
Mailing Address - Phone:503-933-3364
Mailing Address - Fax:
Practice Address - Street 1:4125 NE AINSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7940
Practice Address - Country:US
Practice Address - Phone:503-933-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion