Provider Demographics
NPI:1891684973
Name:MUNOZ, KENNETH (RN)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 REVERE CIR APT 7
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3479
Mailing Address - Country:US
Mailing Address - Phone:731-313-1790
Mailing Address - Fax:
Practice Address - Street 1:12 REVERE CIR APT 7
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3479
Practice Address - Country:US
Practice Address - Phone:731-313-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN252308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse