Kenneth A Visser, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY0002667 Issued in FL

Practice address

1720 El Jobean Rd.
Suite 111
Port Charlotte, FL 33948-1286

Phone

(941) 927-4797

Fax

(941) 927-4797

NPI assigned

Jun 3, 2006

Last updated

Jun 20, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1225076888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2246 CIRCLEWOOD DR.",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342315741",
            "telephone_number": "941-927-4797",
            "fax_number": "941-927-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 EL JOBEAN RD.",
            "address_2": "SUITE 111",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481286",
            "telephone_number": "941-927-4797",
            "fax_number": "941-927-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISSER",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY2667",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY0002667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Marcos Vina, M.D.
• Virtus Health, LLC
• Visionworks Inc (Visionworks)
• Visionworks, Inc. (Visionworks)
• Diana Lynn Visser-Fartek, OTA16477
• Johanny Vizcarrondo Colon
• Timothy Vogt, PHARMD
• Galina Victorovna Vos
• Kristen Vulgamore, APRN
• Lisa Marie Vullo, LCSW

• Psychologist in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.