Bostic, Kenneth

Bostic, Kenneth is an sole proprietor health care provider with primary practice located at 1061 Harmon Ave Winn Army Community Hospital Ste1D03, Fort Stewart GA 31314-5641. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Bostic, Kenneth can be contacted via phone (912) 435-5254.

Contact Information

Primary practice address
1061 Harmon Ave Winn Army Community Hospital Ste1D03 Fort Stewart GA 31314-5641
Phone: (912) 435-5254
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 003528 Georgia

Profile Details

NPI number 1043360597
LBN Legal business name Bostic, Kenneth
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 10th, 2007
Last updated Feb 23rd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043360597 NPPES
Georgia MEDICAID 641480416A
Georgia MEDICAID 641480416B
Georgia MEDICAID 641480416C

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