MR. KENNETH LEE RUSSELL (NPI# 1639661192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639661192 |
| Entity Type | Individual |
| Full Name | MR. KENNETH LEE RUSSELL |
| Other Name | N/A N/A N/A |
| Credential | NAVY SOIDC |
| Practice Address |
3d Marine Raider Battalion Camp Lejeune NC 28546 |
| Mailing Address |
1101 Maren Cv Apt 102 Sneads Ferry NC 28460-0080 |
| Practice Telephone | 3608081590 |
| Mailing Telephone | 3608081590 |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NAVY/DOD | 1391428740 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245577378 | Kenneth Ladon Russell | Counselor | 11000 Springhollow Rd, Oklahoma City, OK 73120-5021 | 2013-01-09 |
| 1205033719 | Kenneth L Russell | Dentist | 2160 South 1000 East, Salt Lake City, UT 84106 | 2007-06-28 |
| 1164510665 | Kenneth William Russell | Dentist | 17121 Se 270th Place, Covington, WA 98042 | 2006-10-10 |
| 1366543258 | Kenneth R Russell | Dentist | 1480 Rymco Dr Ste B, Winston Salem, NC 27103-2944 | 2006-09-26 |
| 1588713002 | Kenneth C Russell | Social Worker | 283 Main St, Catskill, NY 12414-1512 | 2007-01-10 |
| 1851477509 | Kenneth J Russell | Radiology | Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Seattle, WA 98109 | 2006-10-27 |
| 1285719799 | Kenneth Royal Russell Jr. | Pharmacist | 310 W Losey St, Scott Afb, IL 62225-5250 | 2006-10-25 |
| 1205927829 | Kenneth L Russell | Internal Medicine | 514 S Bonham St, Mexia, TX 76667-3600 | 2006-09-27 |
| Street Address |
3D MARINE RAIDER BATTALION |
| City | CAMP LEJEUNE |
| State | NC |
| Zip Code | 28546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053932145 | Nicholas Anthony Quarto | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28542-0073 | 2020-04-30 |
| 1497376669 | Michael Sola | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28542-0073 | 2020-04-29 |
| 1447720412 | William Anthony Mcgrath | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28542 | 2018-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| 1700317088 | Jessica Miller | Counselor | 110b Branchwood Dr, Jacksonville, NC 28546 | 2017-03-27 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820002 | Levi Para | Military Health Care Provider | 2d Reconnaissance Bn, Psc 20138, Camp Lejeune, NC 28452-0138 | 2020-10-29 |
| 1699306670 | Dominick Ciampo | Military Health Care Provider | A66 Boat Basin Road, Camp Lejeune, NC 28542 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1881243525 | Alexander Thomas Rodgers | Military Health Care Provider | 2nd Raider Battalion, A66 Boat Basin Rd, Camp Lejeune, NC 28542 | 2019-09-05 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1578032504 | Brendon Earl Dumas | Military Health Care Provider | Rr612 Everett Creek Road, Camp Lejeune, NC 28542 | 2018-11-20 |
| 1053896514 | Roy Atallah | Military Health Care Provider | 2nd Marine Raider Battalion, Camp Lejeune, NC 28542 | 2018-10-01 |
| 1760967509 | Sergeous Evgeney Anikin-dick | Military Health Care Provider | 2d Marine Raider Battalion Psc 20183, Camp Lejeune, NC 28542 | 2018-09-27 |
| 1295212199 | Ryan Loseke | Military Health Care Provider | 3d Mrb, Camp Lejeune, NC 28460 | 2018-07-24 |
| Find all providers in CAMP LEJEUNE | ||||
| City | CAMP LEJEUNE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on MR. KENNETH LEE RUSSELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.