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 1:9290 BALDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5505
Mailing Address - Country:US
Mailing Address - Phone:850-472-0123
Mailing Address - Fax:850-472-0122
Practice Address - Street 1:9290 BALDRIDGE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5505
Practice Address - Country:US
Practice Address - Phone:850-472-0123
Practice Address - Fax:850-472-0122
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120701363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical