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Individual
MR. KENNETH D MORRISON
Active
Individual
MR. KENNETH D MORRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC862
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001400660
ANTHEM PROVIDER ID
—
01
—
14556232
CAQH PROVIDER ID
—
05
—
300040508
—
IN
05
—
7100631240
—
KY
01
—
CS2027500153
CARESOURCE PROVIDER ID NUMBER
—
01
—
PDZ000000419794
AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
—
Enumeration date
09/23/2019
Last updated
01/12/2021
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