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General NPI Number Information
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NPI Number | 1497089130
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Entity Type | Individual
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Provider Name | KENNETH WAYNE KEITH JR. M.L.T.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 800 ZORN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 502-287-5046
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Fax |
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Provider Business Mailing Address
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Address Line | 7806 FLOYDSBURG RD
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City | CRESTWOOD
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State | KY
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Zip | 40014-9294
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Country | US
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Telephone | 502-243-9429
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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 | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number | 244276
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License Number State | KY
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