Lake, Kenneth Douglas

Lake, Kenneth Douglas is an individual health care provider with primary practice located at 300 Mack Rd , Asheboro NC 27205-1066. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Lake, Kenneth Douglas can be contacted via phone (336) 625-1172.

Contact Information

Primary practice address
300 Mack Rd Asheboro NC 27205-1066
Phone: (336) 625-1172
Fax: (336) 625-6434
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 101208 North Carolina

Profile Details

NPI number 1518981927
LBN Legal business name Lake, Kenneth Douglas
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Feb 4th, 2019 - about 7 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 1518981927 NPPES
North Carolina Other 1582K BCBS NC
North Carolina MEDICAID 1518981927 BCBS NC

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