Headen, Kenneth Jay

Headen, Kenneth Jay is an sole proprietor health care provider with primary practice located at 806 Summit Ave , Greensboro NC 27405-7861. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Headen, Kenneth Jay can be contacted via phone (336) 437-2354.

Contact Information

Primary practice address
806 Summit Ave Greensboro NC 27405-7861
Phone: (336) 437-2354
Fax: (336) 279-1226
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 9400266 North Carolina

Profile Details

NPI number 1366654329
LBN Legal business name Headen, Kenneth Jay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 4th, 2007
Last updated Jun 29th, 2015 - 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 1366654329 NPPES
North Carolina MEDICAID 5917028

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