Individual
KENNETH E FERSLEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
BUILDING 6, MAGNOLIA AND FIFTH, MOUNTAIN HOME, TN 37684-0699
(423) 439-6424
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-6424
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
ML9814
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3401264
LAB MEDICARE PIN
TN
Enumeration date
01/14/2008
Last updated
01/14/2008
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