Provider Demographics
NPI:1023487121
Name:BROWN, KENNETH III (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BROWN
Suffix:III
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2416
Mailing Address - Country:US
Mailing Address - Phone:913-620-4715
Mailing Address - Fax:
Practice Address - Street 1:1500 S SIOUX DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2416
Practice Address - Country:US
Practice Address - Phone:913-620-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150324202255A2300X
KS24-010652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer