Provider Demographics
NPI:1912925322
Name:KOKENES, JOHN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KOKENES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5326
Mailing Address - Country:US
Mailing Address - Phone:843-665-2899
Mailing Address - Fax:
Practice Address - Street 1:805 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-664-3301
Practice Address - Fax:843-664-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN584367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1145Medicaid
SCAN1145Medicaid
SCQ330807234Medicare ID - Type Unspecified