Provider Demographics
NPI:1891509394
Name:EGLE, KENNETH WAYNE
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:EGLE
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:PO BOX 2134
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-2134
Mailing Address - Country:US
Mailing Address - Phone:307-231-6205
Mailing Address - Fax:
Practice Address - Street 1:909 14TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1403
Practice Address - Country:US
Practice Address - Phone:307-231-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care