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General NPI Number Information
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NPI Number | 1710941059
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Entity Type | Individual
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Provider Name | KENNETH COLEMAN RICE PA
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 6300 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32940-2028
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Country | US
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Telephone | 321-242-7425
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 N WICKHAM RD STE 101
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City | MELBOURNE
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State | FL
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Zip | 32940-2023
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Country | US
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Telephone | 321-242-7425
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-09853
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3323
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License Number State | FL
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