Provider Demographics
NPI:1417468620
Name:KNOX, KENNETH JUNIUS
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JUNIUS
Last Name:KNOX
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 1:458 PRITCHETT LN
Mailing Address - Street 2:
Mailing Address - City:BLAIRS
Mailing Address - State:VA
Mailing Address - Zip Code:24527-2236
Mailing Address - Country:US
Mailing Address - Phone:434-857-5908
Mailing Address - Fax:434-857-5908
Practice Address - Street 1:458 PRITCHETT LN
Practice Address - Street 2:
Practice Address - City:BLAIRS
Practice Address - State:VA
Practice Address - Zip Code:24527-2236
Practice Address - Country:US
Practice Address - Phone:434-857-5908
Practice Address - Fax:434-857-5908
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60236087172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver