Provider Demographics
NPI:1518951896
Name:MANION, KENNY JOE (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:JOE
Last Name:MANION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S L ROGER WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1191
Mailing Address - Country:US
Mailing Address - Phone:270-651-7796
Mailing Address - Fax:270-651-7074
Practice Address - Street 1:411 S L ROGER WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1191
Practice Address - Country:US
Practice Address - Phone:270-651-7796
Practice Address - Fax:270-651-7074
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64248065Medicaid
KY64248065Medicaid
C67703Medicare UPIN