MEDICARE: KK&J MEDICAL DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1699536722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KK&J MEDICAL DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	6625 ARGYLE FOREST BLVD STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6126
Country	:	US
Telephone Number	:	904-862-1944
Fax Number	:

Provider Business Practice Location Address
First Line	:	6625 ARGYLE FOREST BLVD STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6126
Country	:	US
Telephone Number	:	803-613-4191
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE D BROWN
Credential	:	LPN
Telephone Number	:	803-849-9803

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	04/26/2024

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