Provider Demographics
NPI:1740514835
Name:TURNER, KENNETH RAY
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAY
Last Name:TURNER
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 1:4059 NC STATE HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604
Mailing Address - Country:US
Mailing Address - Phone:865-388-8424
Mailing Address - Fax:
Practice Address - Street 1:4059 NC STATE HWY 105 HWY
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-0000
Practice Address - Country:US
Practice Address - Phone:865-388-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0065128Medicaid