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General NPI Number Information
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NPI Number | 1699536722
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Entity Type | Organization
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Legal Business Name | KK&J MEDICAL DIAGNOSTICS LLC
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 6625 ARGYLE FOREST BLVD STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6126
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Country | US
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Telephone | 803-613-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 6625 ARGYLE FOREST BLVD STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6126
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Country | US
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Telephone | 904-862-1944
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASMINE D BROWN
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Credential | LPN
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Telephone | 803-849-9803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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