MR. KENNETH JOHN BANNON (NPI# 1821055047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821055047 |
| Entity Type | Individual |
| Full Name | MR. KENNETH JOHN BANNON |
| Credential | BSPA-C |
| Practice Address |
111 Salem Avenue Suite 302 Carbondale PA 18407-2574 |
| Mailing Address |
601 Park St Honesdale PA 18431-1445 |
| Practice Telephone | 5702822031 |
| Practice Fax Number | 5702822534 |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2015-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MA001023L | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 SALEM AVENUE SUITE 302 |
| City | CARBONDALE |
| State | PA |
| Zip Code | 18407-2574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235761784 | Ashley Ettinger | Counselor | 38 North Scott Road, Carbondale, PA 18407 | 2020-02-12 |
| 1639723109 | Dana Marie Marmo | Counselor | 141 Salem Ave Suite 104, Carbondale, PA 18407 | 2019-08-01 |
| 1831694991 | William Vitzakovitch | Physical Therapist | 504 1/2 Scranton Carbondale Hwy, Mayfield, PA 18407 | 2018-03-29 |
| 1205345014 | The Young Men's Christian Association of Carbondale | Health Educator | 82 N Main Street, Carbondale, PA 18407 | 2017-09-25 |
| 1942722327 | Jamee Ruddy | Early Intervention Provider Agency | 77 Jefferson Street, Simpson, PA 18407 | 2017-07-07 |
| 1417181082 | Paul Erik Larson | Specialist/Technologist | 101 Brooklyn Street/business Route 6, Carbondale, PA 18407 | 2009-05-11 |
| 1316061708 | Christine Marie Roberts | Occupational Therapist | Carbondale Nursing Home, 10 Hart Place, Carbondale, PA 18407 | 2007-03-19 |
| 1407944036 | Brian John Piatak | Chiropractor | 30 N Scott Street, Carbondale, PA 18407 | 2006-10-10 |
| 1427556133 | Brianna Marie Bennici | Occupational Therapy Assistant | 45 N Scott St, Carbondale, PA 18407 | 2018-01-28 |
| 1144632332 | Dannielle S Hafler | Social Worker | 32 N Main St, Carbondale, PA 18407 | 2014-05-22 |
| Find all providers in zip 18407 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821618471 | Derrik Abell | Physician Assistant | 11648 Rolling Meadows Ln, Carbondale, IL 62901-0750 | 2020-04-23 |
| 1598277907 | Mallory Lindberg | Physician Assistant | 207 W Jackson St Ste 201, Carbondale, IL 62901-1408 | 2017-10-26 |
| 1790009488 | Northeast Physician Housecalls, Inc. | Physician Assistant | 52 Dundaff St, Carbondale, PA 18407-1879 | 2010-03-24 |
| 1164618633 | Rachel Marie Sargent | Physician Assistant | 600 N. Giant City Rd, Carbondale, IL 62902-6413 | 2007-09-19 |
| 1851502421 | Kelly K Hand | Physician Assistant | 665 E Lake Rd, Carbondale, IL 62901-5347 | 2007-05-25 |
| 1073729877 | Kathleen Ann Dodd | Physician Assistant | 374 East Grand, Carbondale, IL 62901-6740 | 2007-05-16 |
| 1376680462 | Gabriel A Martin | Physician Assistant | 103 S Washington St, Suite 202, Carbondale, IL 62901-3030 | 2007-01-30 |
| 1649385873 | Mary L Brandenburg | Physician Assistant | 1301 E Walnut St, Carbondale, IL 62901-5004 | 2006-08-20 |
| 1841237120 | Patricia A Boudet | Physician Assistant | 404 S Lewis Ln, Carbondale, IL 62901-3547 | 2006-06-02 |
| 1871542811 | Michael Anthony Bryant | Physician Assistant | 305 W Jackson St Ste 103, Carbondale, IL 62901-1474 | 2006-05-08 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 18407 |
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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.