Provider Demographics
NPI:1346748001
Name:KAISER, KENNETH JR (NP-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KAISER
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 SUMMERGATE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1863
Mailing Address - Country:US
Mailing Address - Phone:936-537-1990
Mailing Address - Fax:
Practice Address - Street 1:12073 N. GRAND PARKWAY E
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357
Practice Address - Country:US
Practice Address - Phone:281-306-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily