Individual
DR. KENNETH WAYNE EDMISSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ND EDD RNC FNP CRNA
Contact information
Practice address
225 MEDICAL CENTER DR, #405, PADUCAH, KY 42003-7914
(270) 441-4750
Mailing address
225 MEDICAL CENTER DR, #405, PADUCAH, KY 42003-7914
(270) 441-4750
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024162111
VA
363LF0000X
Family Nurse Practitioner
APN0000006429
TN
367500000X
Certified Registered Nurse Anesthetist
12386-NA
OH
367500000X
Certified Registered Nurse Anesthetist
1659
TX
367500000X
Certified Registered Nurse Anesthetist
3007055
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
6429
TN
Other
Enumeration date
06/26/2005
Last updated
10/04/2011
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