Provider Demographics
NPI:1912076704
Name:MCCARTNEY, KENNETH KEVIN
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:KEVIN
Last Name:MCCARTNEY
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:USS MEMPHIS
Mailing Address - Street 2:SSN 691
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09578-2074
Mailing Address - Country:US
Mailing Address - Phone:860-694-4644
Mailing Address - Fax:
Practice Address - Street 1:153 GRAND MARSH BAY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04669
Practice Address - Country:US
Practice Address - Phone:207-907-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman