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Individual

MR. KENNETH PAUL MANSELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1050 W CARROLL ST, KISSIMMEE, FL 34741-1268
(407) 518-9775
(407) 518-0094
Mailing address
4473 EMERSON PARK DR, #101, ORLANDO, FL 32839-6107
(941) 961-3977

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9101437

Other

Enumeration date
10/17/2006
Last updated
07/08/2007
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