Provider Demographics
NPI:1922786888
Name:K & J AUTO LLC
Entity Type:Organization
Organization Name:K & J AUTO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER
Authorized Official - Prefix:
Authorized Official - First Name:SCHKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON-NELOMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-655-7473
Mailing Address - Street 1:1275 FAIRWAY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8397
Mailing Address - Country:US
Mailing Address - Phone:904-655-7473
Mailing Address - Fax:
Practice Address - Street 1:1275 FAIRWAY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8397
Practice Address - Country:US
Practice Address - Phone:904-655-7473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K & J AUTO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health