Provider Demographics
NPI:1871815357
Name:JONES, KENNETH (NP)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9109
Mailing Address - Country:US
Mailing Address - Phone:270-745-8469
Mailing Address - Fax:270-745-8233
Practice Address - Street 1:600 CORVETTE DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9109
Practice Address - Country:US
Practice Address - Phone:270-745-8469
Practice Address - Fax:270-745-8233
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY964P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health