Individual
MR. KENNETH CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
9 PARK PL, SWANSEA, IL 62226-2967
(618) 233-5722
(618) 233-7069
Mailing address
9 PARK PL, SWANSEA, IL 62226-2967
(618) 233-5722
(618) 233-7069
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
041296721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041296721
LICENSE
IL
01
—
084592
LICENSE
MO
Enumeration date
06/30/2005
Last updated
11/02/2009
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