Individual
MR. KENNETH A HAVENSTRITE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP-BC, NP
Contact information
Practice address
2598 W WHITE RIVET BLVD, MUNCIE, IN 47303-5251
(765) 284-7738
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
28177733A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71004277A
IN
Other
Enumeration date
11/16/2012
Last updated
09/29/2021
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