Kenneth J Kohutek, PHD
Individual provider Active NPI Psychiatric Hospital · Vernon, TX
NPI 1104946938 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104946938
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- License
- 22814 (TX)
- Practice address
- 4730 College Dr
6515 Kemp Boulevard
Vernon, TX 76384-4009 - Phone
- (940) 552-9901
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22814 | TX | MD | Psychiatric Hospital |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital | 283Q00000X | 22814 | TX | Yes |
Addresses
Primary practice location
4730 College Dr
6515 Kemp Boulevard
Vernon, TX 76384-4009
Mailing address
4730 College Dr
6515 Kemp Boulevard
Vernon, TX 76384-4009
Phone (940) 552-9901
Other providers in Vernon, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.