Provider Demographics
NPI:1508119470
Name:HOUSTON, KENNETH LAMONT JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LAMONT
Last Name:HOUSTON
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2713
Mailing Address - Country:US
Mailing Address - Phone:716-602-0791
Mailing Address - Fax:
Practice Address - Street 1:43 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2713
Practice Address - Country:US
Practice Address - Phone:716-602-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293420164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse