Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 6421 | KS |
NPI | 1477893246 |
---|---|
Provider Name | Mrs. Linda K Kenworthy |
First Address | Wamego, KS 66547-1713 |
Second Address | Wamego, KS 66547-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2013 |
Last Update Date | 15/02/2013 |