Provider Demographics
NPI:1639292121
Name:CARGILE, KENNETH ROWLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROWLAND
Last Name:CARGILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 E MAIN ST
Mailing Address - Street 2:FHU FAMILY CLINIC
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2306
Mailing Address - Country:US
Mailing Address - Phone:731-989-6980
Mailing Address - Fax:731-983-3099
Practice Address - Street 1:158 E MAIN ST
Practice Address - Street 2:FHU FAMILY CLINIC
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2306
Practice Address - Country:US
Practice Address - Phone:731-989-6980
Practice Address - Fax:731-983-3099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD023570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB30464Medicare UPIN