Provider Demographics
NPI:1720127830
Name:JONES, KENNETH E (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-1192
Mailing Address - Country:US
Mailing Address - Phone:660-885-5511
Mailing Address - Fax:660-885-8496
Practice Address - Street 1:1600 NORTH SECOND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1192
Practice Address - Country:US
Practice Address - Phone:660-885-5511
Practice Address - Fax:660-885-8496
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS185432085R0202X
MOR2E222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242050557Medicaid
MO242050557Medicaid
7870067Medicare ID - Type Unspecified