Individual
RUSSELL KENWORTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
312 RITA LN, LONG BEACH, MS 39560-4338
(228) 234-4959
Mailing address
312 RITA LN, LONG BEACH, MS 39560-4338
(228) 234-4959
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0159
MS
Other
Enumeration date
06/27/2014
Last updated
06/27/2014
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