Provider Demographics
NPI:1669731220
Name:JARETT, KENNETH EDWARD
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWARD
Last Name:JARETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1045
Mailing Address - Country:US
Mailing Address - Phone:785-204-2301
Mailing Address - Fax:
Practice Address - Street 1:417 N OAK ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1045
Practice Address - Country:US
Practice Address - Phone:785-204-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant