Provider Demographics
NPI:1437996899
Name:STERN, KENNETH MICHAEL JR (RN)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:STERN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:MICKEY
Other - Middle Name:
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3903 NW COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1635
Mailing Address - Country:US
Mailing Address - Phone:520-609-9006
Mailing Address - Fax:
Practice Address - Street 1:3903 NW COUNTRY LN
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1635
Practice Address - Country:US
Practice Address - Phone:520-609-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61456091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse