Individual
KEVIN ENSIGN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8503
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8503
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2027601
KY
Other
Enumeration date
01/08/2009
Last updated
01/08/2009
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