Kenneth R. Warren, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0000011892 Issued in TN

Practice address

31 Physicians Dr
Suite 1
Jackson, TN 38305-2071

Phone

(731) 664-0103

Fax

(731) 664-5666

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336089600000",
    "number": "1043221856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 PHYSICIANS DR",
            "address_2": "SUITE 1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052071",
            "telephone_number": "731-664-0103",
            "fax_number": "731-664-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 PHYSICIANS DR",
            "address_2": "SUITE 1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052071",
            "telephone_number": "731-664-0103",
            "fax_number": "731-664-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "KENNETH",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2012-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "0000011892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508946",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4201533",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey G Wardlow, CASE MANAGER
• Phyllis A Wardlow, PTA
• Chenise Ware, CASE MANAGER
• James G Warmbrod, MD
• Karl H Warren, D.D.S.
• Mitzi Warren
• Kai D Washington, ATC, LAT
• Leona Washington, RN
• Terry L Washington, MD
• James A. Watkins, P.T.

• Family Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.