Provider Demographics
NPI:1528897170
Name:LADNER, KENNETH RAY
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:LADNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6075 GRELOT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3639
Mailing Address - Country:US
Mailing Address - Phone:228-547-3683
Mailing Address - Fax:
Practice Address - Street 1:5721 USA DRIVE NORTH 5721 USA DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-445-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program