KENNETH R. WARREN (NPI# 1043221856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043221856 |
| Entity Type | Individual |
| Full Name | KENNETH R. WARREN |
| Credential | M.D. |
| Practice Address |
31 Physicians Dr Suite 1 Jackson TN 38305-2071 |
| Practice Telephone | 7316640103 |
| Practice Fax Number | 7316645666 |
| Mailing Telephone | 7316640103 |
| Mailing Fax Number | 7316645666 |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2012-05-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0000011892 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BLUE CROSS BLUE SHIELD | 4201533 | 01 |
| TN | 1508946 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881928612 | Kenneth Warren | Counselor | 18000 Coyle, Detroit, MI 48235-2825 | 2009-09-26 |
| 1689854382 | Kenneth D Warren Jr. | Podiatrist | 2 Berry Ct, Kennebunk, ME 04043-6812 | 2007-11-09 |
| 1013909324 | Kenneth P Warren | Nurse Practitioner | 1822 E 15th St, Suite A, Tulsa, OK 74104-4645 | 2005-08-22 |
| 1730674987 | Kenneth Warren | Peer Specialist | 1744 Payne Ave, Cleveland, OH 44114-2910 | 2018-06-28 |
| 1790712552 | Kenneth Christian Warren | Physical Therapist | 665 Gaines School Rd, Athens, GA 30605-3127 | 2006-06-27 |
| Street Address |
31 PHYSICIANS DR SUITE 1 |
| City | JACKSON |
| State | TN |
| Zip Code | 38305-2071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730488669 | Lindsay T Crocker | Nurse Practitioner | 31 Physicians Dr, Jackson, TN 38305-2071 | 2011-03-17 |
| 1518158021 | Goodwin & Associates, P.C. | Specialist | 31 Physicians Dr, Jackson, TN 38305-2071 | 2007-08-08 |
| 1518169812 | Kenneth R. W. Warren, M.d.p.c. | Family Medicine | 31 Physicians Dr, Jackson, TN 38305-2071 | 2007-05-31 |
| 1952528077 | Kevin G Gray | Internal Medicine | 31 Physicians Dr, Jackson, TN 38305-2071 | 2007-04-19 |
| 1174618516 | Fred J Sesti | Nurse Practitioner | 31 Physicians Dr, Jackson, TN 38305-2071 | 2006-10-03 |
| 1841392974 | Mary Blondell Deal | Nurse Practitioner | 31 Physicians Dr, Jackson, TN 38305-2071 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1700361904 | James Cowie | Psychologist | 156c West University Pkwy, Jackson, TN 38305 | 2018-10-03 |
| 1700372109 | Chad Zawacki | Physician Assistant | 147 North Star Drive, Jackson, TN 38305 | 2018-07-09 |
| 1104323070 | Golden Years Adult Day Care | Clinic/Center | 155 Carriage Dr Suite A, Jackson, TN 38305 | 2018-04-09 |
| 1245754563 | Tanika Annette Gillard | Massage Therapist | 4 Hampton Ln, Jackson, TN 38305 | 2017-07-28 |
| 1316488117 | Lakisha T Ingram | Counselor | 168 Greencastle Dr, Jackson, TN 38305 | 2017-03-13 |
| 1619421567 | D & L Wellness Inc | Community/Behavioral Health | 154 Carriage House Dr., Jackson, TN 38305 | 2016-08-09 |
| 1649637638 | Advance Choice Home Care LLC | In Home Supportive Care | 1028 Ashport Rd., Jackson, TN 38305 | 2016-01-21 |
| 1942666151 | Neurohealth Solutions Inc. | Clinic/Center | 174 Murray Guard Dr. Suite E, Jackson, TN 38305 | 2016-01-05 |
| Find all providers in zip 38305 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1003470758 | Central Mississippi Health Services, Inc | Family Medicine | 3450 Highway 80 W Ste 71, Jackson, MS 39209-7201 | 2019-04-29 |
| 1922515493 | Meaghan Schenk Johnson | Family Medicine | 2969 Curran Dr N # 200, Jackson, MS 39216-4121 | 2018-01-05 |
| 1740795731 | Emily Colleen Dunaway | Family Medicine | 1227 N State St # 101, Jackson, MS 39202-2002 | 2017-12-12 |
| 1679086367 | Hope Np House Call Practice | Family Medicine | 98 Grandview Ave, Jackson, OH 45640-9090 | 2017-11-16 |
| 1427585488 | Daniel Matthew Bender | Family Medicine | 455 W Broadway Ave, Jackson, WY 83001-8639 | 2017-05-21 |
| 1891235289 | Logan Hardin | Family Medicine | 1270 Union University Dr Ste A, Jackson, TN 38305-3856 | 2017-03-03 |
| 1255782843 | Seth Tyler Koehler | Family Medicine | 2600 E Main St, Jackson, MO 63755-2473 | 2016-06-25 |
| 1720495245 | Gopi Patel | Family Medicine | 27 S Cooks Bridge Rd Ste 2-1, Jackson, NJ 08527-2524 | 2014-07-16 |
| 1154735165 | Lk Physicians Services Pllc | Family Medicine | 36 Lake Pointe Dr, Jackson, TN 38305-8113 | 2014-06-17 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.