# MR. KENNETH CLEMENTS

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

## Provider details

- **NPI number:** 1215934757
- **Gender:** Man
- **Credential:** RNFA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WR0006X | Registered Nurse First Assistant | 041296721 | IL | Yes |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 11/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 041296721 | LICENSE | IL |
| 01 | — | 084592 | LICENSE | MO |