Kenneth Lee Russell, NAVY SOIDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3D Marine Raider Battalion
Camp Lejeune, NC 28546

Phone

(360) 808-1590

NPI assigned

May 31, 2018

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 1

Other names 1

• N/a N/a N/a Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1639661192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MAREN CV APT 102",
            "city": "SNEADS FERRY",
            "state": "NC",
            "postal_code": "284600080",
            "telephone_number": "360-808-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3D MARINE RAIDER BATTALION",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "360-808-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KENNETH",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "NAVY SOIDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAVY/DOD",
            "identifier": "1391428740",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "credential": "HM1 RUSSELL KENNETH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Carl Joseph Ruoff Jr., O.D.
• Jason Rupprecht, DDS
• David Alan Russell, DDS
• Jeffrey D. Russell, AUD
• Kathy Russell, RN
• Matthew Aaron Russell, D.M.D.
• Quaid A Russell, DDS
• Samantha Ingrid Rustia, DDS
• Anna Lynn Rutherford, M.D.
• Robert Plympton Rutter IV, D.O.

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; 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.