Individual
KENNETH R. WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31 PHYSICIANS DR, SUITE 1, JACKSON, TN 38305-2071
(731) 664-0103
(731) 664-5666
Mailing address
31 PHYSICIANS DR, SUITE 1, JACKSON, TN 38305-2071
(731) 664-0103
(731) 664-5666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0000011892
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508946
—
TN
01
—
4201533
BLUE CROSS BLUE SHIELD
TN
Enumeration date
08/10/2006
Last updated
05/04/2012
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