# MR. KENNETH D MORRISON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1205487170
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | TC862 | KY | Yes |

## Other

- **Enumeration date:** 09/23/2019
- **Last updated:** 01/12/2021

## 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 | — |