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General NPI Number Information
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NPI Number | 1013584655
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Entity Type | Individual
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Provider Name | KENNETH GRIFFIN RN WCC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 1 SILVERCREST DR
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City | NEW ALBANY
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State | IN
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Zip | 47150-7800
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Country | US
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Telephone | 812-542-6720
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Fax |
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Provider Business Mailing Address
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Address Line | 117 MEADOW DR
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City | SELLERSBURG
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State | IN
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Zip | 47172-9785
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Country | US
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Telephone | 502-718-1612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28208427A
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License Number State | IN
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