Craven, Kenneth

Craven, Kenneth is an individual health care provider with primary practice located at 1220 Jefferson St , Laurel MS 39440-4355. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Craven, Kenneth can be contacted via phone (601) 399-6167.

Contact Information

Primary practice address
1220 Jefferson St Laurel MS 39440-4355
Phone: (601) 399-6167
Fax: (601) 399-6281
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R791115 Mississippi

Profile Details

NPI number 1750325528
LBN Legal business name Craven, Kenneth
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Feb 11th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750325528 NPPES
Mississippi MEDICAID 00121387

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