Provider Demographics
NPI:1366212482
Name:JUDE, KENITH TAYLOR
Entity type:Individual
Prefix:
First Name:KENITH
Middle Name:TAYLOR
Last Name:JUDE
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 1:53 DEMPSEY HOUSING ST APT 25E
Mailing Address - Street 2:
Mailing Address - City:WARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:41267-8937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 DEMPSEY HOUSING ST APT 25E
Practice Address - Street 2:
Practice Address - City:WARFIELD
Practice Address - State:KY
Practice Address - Zip Code:41267-8937
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant