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NPI Code Detail

MEDICARE: KENNETH COLEMAN RICE PA

MEDICARE: KENNETH COLEMAN RICE PA
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
1363A00000XPhysician Assistant0010-09853NC
2363A00000XPhysician AssistantPA3323FL

General Provider Information

NPI Number : 1710941059
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH COLEMAN RICE PA
Provider Business Mailing Address
First Line : 6300 N WICKHAM RD STE 101
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2023
Country : US
Telephone Number : 321-242-7425
Fax Number :
Provider Business Practice Location Address
First Line : 6300 N WICKHAM RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32940-2028
Country : US
Telephone Number : 321-242-7425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 02/14/2025

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Directions to “ KENNETH COLEMAN RICE PA” Practice Location

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