Individual
KENNETH IAN PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-7100
Mailing address
1572 OVERTON PARK AVE APT 21, MEMPHIS, TN 38112-5165
(757) 652-6578
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
10008152APRN-CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
27755
TN
Other
Enumeration date
04/19/2020
Last updated
07/06/2023
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