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Individual
MR. KENNETH BOSTIC
Active
Individual
MR. KENNETH BOSTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003528
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
641480416A
—
GA
05
—
641480416B
—
GA
05
—
641480416C
—
GA
Enumeration date
01/10/2007
Last updated
06/11/2026
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