Provider Demographics
NPI:1134736085
Name:KNOWLES, KENNETH E (RN)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:E
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1515 E HEWETT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3348
Mailing Address - Country:US
Mailing Address - Phone:770-862-0103
Mailing Address - Fax:
Practice Address - Street 1:1515 E HEWETT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3348
Practice Address - Country:US
Practice Address - Phone:770-862-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158354163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice