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DR. KENNETH LANCE KNICKERBOCKER D.O. NPI 1316157472


NPI Information

NPI: 1316157472
Provider Name: DR. KENNETH LANCE KNICKERBOCKER, D.O.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Address:
19900 STATE ROUTE 739
MARYSVILLE, OH
ZIP 43040
Phone: (937) 642-0298
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DR. Kenneth Lance Knickerbocker, D.O. is a family medicine in Marysville, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Kenneth Lance Knickerbocker, D.O. NPI is 1316157472. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

19900 STATE ROUTE 739
MARYSVILLE, OH
ZIP 43040-256
Phone: (937) 642-0298
Fax: (937) 645-8329

The enumeration date for this NPI number is 5/23/2007 and was last updated on 12/16/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine34 . 008177OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
134 . 008177OTHEROHIOSTATE LICENSE
23203OTHEROKLAHOMASTATE LICENSE
3F89383MEDICARE UPIN
40102036816OTHERVIRGINIASTATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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