Provider Demographics
NPI:1366233504
Name:CARNES, KENNETH GERARD
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GERARD
Last Name:CARNES
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 1:2649 PILLORY POINTE
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2316
Mailing Address - Country:US
Mailing Address - Phone:917-858-1458
Mailing Address - Fax:
Practice Address - Street 1:2649 PILLORY POINTE
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78108-2316
Practice Address - Country:US
Practice Address - Phone:917-858-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT137726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist