Individual
KALEB JACKSON KITCHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
214 W LONGVIEW DR, PORTLAND, TN 37148-1641
(615) 325-5237
Mailing address
214 W LONGVIEW DR, PORTLAND, TN 37148-1641
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
0000235432
TN
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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