Provider Demographics
NPI:1518391168
Name:MANNING, KAY LAMOUNT
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LAMOUNT
Last Name:MANNING
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 1:408 HALLER ST # 1
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7439
Mailing Address - Country:US
Mailing Address - Phone:907-394-5280
Mailing Address - Fax:
Practice Address - Street 1:408 HALLER ST # 1
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7439
Practice Address - Country:US
Practice Address - Phone:907-394-5280
Practice Address - Fax:907-283-0408
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK994603251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health