Individual
KENNETH KAISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4113
(601) 856-2460
(601) 856-4687
Mailing address
11 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4113
(601) 856-2460
(601) 856-4687
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R856338
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125332
—
MN
05
—
00125332
—
MS
01
—
202011213A
BLUE CROSS
MS
Enumeration date
06/16/2006
Last updated
02/25/2011
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