Healthcare Provider Details

I. General information

NPI: 1679435929
Provider Name (Legal Business Name): KENNETH KECK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HARMON AVE
COLUMBUS OH
43223
US

IV. Provider business mailing address

PO BOX 11
NEWARK OH
43058-0011
US

V. Phone/Fax

Practice location:
  • Phone: 614-222-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.512223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: