Healthcare Provider Details

I. General information

NPI: 1457486755
Provider Name (Legal Business Name): MR. KENNON DANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-4318
US

IV. Provider business mailing address

P O BOX 3488 DEPT 05-113
TUPELO MS
38803-3488
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-1111
  • Fax:
Mailing address:
  • Phone: 678-553-8150
  • Fax: 678-553-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR726397
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: