Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC001697L | PA |
NPI | 1043276132 |
---|---|
Provider Name | Dr. Richard Kenton Koons |
First Address | Lebanon, PA 17046-2842 |
Second Address | Lebanon, PA 17046-2842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
064111 | HIGHMARK (01) | PA |