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NPI Code Detail

MEDICARE: KENNETH WAYNE DUNAWAY PA-C

MEDICARE: KENNETH WAYNE DUNAWAY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPAA10576RXLA

General Provider Information

NPI Number : 1093840860
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH WAYNE DUNAWAY PA-C
Provider Business Mailing Address
First Line : 10141 SANDHILL CT
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-5924
Country : US
Telephone Number : 225-938-6239
Fax Number : 225-926-3346
Provider Business Practice Location Address
First Line : 4550 NORTH BLVD
Second Line : SUITE 100
City : BATON ROUGE
State : LA
Zip : 70806-4013
Country : US
Telephone Number : 225-938-6239
Fax Number : 225-926-3346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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Directions to “ KENNETH WAYNE DUNAWAY PA-C” Practice Location

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