Individual
KENNETH CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, NP-C
Contact information
Practice address
15708 E 45TH PL S, INDEPENDENCE, MO 64055-5212
(816) 726-5492
Mailing address
15708 E. 45TH PL. S., INDEPENDENCE, MO 64055-5212
(816) 726-5492
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2012009273
MO
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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