Kenneth Fanning

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHWH005053 Issued in GA

Practice address

555 Charlie Smith Sr Hwy
Saint Marys, GA 31558-3030

Phone

(904) 616-9096

NPI assigned

Jun 24, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1982273827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 N MARKET ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064540",
            "telephone_number": "904-616-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 CHARLIE SMITH SR HWY",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583030",
            "telephone_number": "904-616-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "KENNETH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "PHWH005053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robyn N Ellis, APRN, FNP-BC
• April Goodwin Emerson, PT, MS
• Kalie E Ertwine, DPT, PT
• Laura M Estes, CRNA
• Family Matters of Coastal Georgia, Inc.
• Shelbie Yvonne Farmer
• Adam Fazilat, CHPA
• Shanell Feldergoodman
• Jennifer Michelle Fine, BS, MOT R//L
• First Coast Emergency Services

• Pharmacist in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; 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.