Individual
KENNETH B ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
621 S NEW BALLAS RD STE 3005B, SAINT LOUIS, MO 63141-8266
(314) 567-5850
Mailing address
621 S BALLAS RD STE 3005B, SAINT LOUIS, MO 63122-5314
(314) 567-5850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002325A
IN
363A00000X
Physician Assistant
Primary
2020040966
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300011444
—
IN
Enumeration date
10/04/2017
Last updated
05/26/2021
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