Healthcare Provider Details

I. General information

NPI: 1538199047
Provider Name (Legal Business Name): KENNETH ALLEN KORN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 OLD BAINBRIDGE RD
TALLAHASSEE FL
32303-5340
US

IV. Provider business mailing address

4638 RUSSELS POND LN
TALLAHASSEE FL
32303-8916
US

V. Phone/Fax

Practice location:
  • Phone: 850-488-2223
  • Fax: 850-414-7237
Mailing address:
  • Phone: 850-562-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9211407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: