Organization
JKN MEDICAL SUPPORT GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BETHEL (OWNER)
(316) 409-3022
Entity
Organization
Contact information
Practice address
13250 EMILY RD APT 1006, DALLAS, TX 75240-5953
(316) 409-3022
Mailing address
13250 EMILY RD APT 1006, DALLAS, TX 75240-5953
(316) 409-3022
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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