Provider Demographics
NPI:1821085770
Name:KENT, VINCENT CARL (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:CARL
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2535
Mailing Address - Country:US
Mailing Address - Phone:901-475-9229
Mailing Address - Fax:901-475-2828
Practice Address - Street 1:107 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2535
Practice Address - Country:US
Practice Address - Phone:901-475-9229
Practice Address - Fax:901-475-2828
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15295207X00000X
TN27521207X00000X
TN027521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4232110OtherBCBS
TN1513566Medicaid
MO1821085770Medicaid
TN4356224OtherBLUE CROSS BLUE SHIELD
TN3097454Medicaid
TN3097454Medicaid
CAA39485Medicare UPIN
TN30974542Medicare PIN