Healthcare Provider Details

I. General information

NPI: 1699536722
Provider Name (Legal Business Name): KK&J MEDICAL DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 ARGYLE FOREST BLVD STE 4
JACKSONVILLE FL
32244-6126
US

IV. Provider business mailing address

6625 ARGYLE FOREST BLVD STE 4
JACKSONVILLE FL
32244-6126
US

V. Phone/Fax

Practice location:
  • Phone: 803-613-4191
  • Fax:
Mailing address:
  • Phone: 904-862-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASMINE D BROWN
Title or Position: OWNER
Credential: LPN
Phone: 803-849-9803