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MR. KENNETH LEE RUSSELL NAVY SOIDC
NPI 1639661192
Military Health Care Provider - Independent Duty Corpsman in Camp Lejeune, NC

Active since May 31, 2018
3D MARINE RAIDER BATTALION, CAMP LEJEUNE, NC 28546(360) 808-1590 Get Directions Write a Review

NPPES record last updated: May 31, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Kenneth Lee Russell Navy Soidc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENNETH LEE RUSSELL NAVY SOIDC (NPI 1639661192) is an individual independent duty corpsman provider in Camp Lejeune, North Carolina and active in the NPI registry since May 2018.

NPPES Registry Identity

NPI1639661192
Entity TypeIndividualMale
Primary Taxonomy1710I1002X
Provider Legal NameMR. KENNETH LEE RUSSELLCredential: NAVY SOIDC
Location Address3D MARINE RAIDER BATTALIONCamp Lejeune, NC 28546
Mailing Address1101 Maren Cv Apt 102Sneads Ferry, NC 28460-0080 · (360) 808-1590
Phone(360) 808-1590
Sole ProprietorYes
Enumeration DateMay 31, 2018
✔ NPI 1639661192 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers
Taxonomy Code1710I1002X
Definition
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.
3D MARINE RAIDER BATTALION, Camp Lejeune, NC 28546
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Other Names 1

Professional Name (2)N/a N/a N/a Hm1 Russell Kenneth

Other Identifiers 1

Other1391428740Navy/dod

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSE CARLOS ORTIZ GRACIA
Physician Assistant (Medical)
3D MARINE RAIDER BATTALION
FPO, AA 28546
Onslow County (910) 440-1947

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Russell's NPI number?

The NPI number for Kenneth Russell is 1639661192. It was assigned to this individual provider in the NPPES registry on May 31, 2018. The provider is also known as N/A N/A N/A Hm1 Russell Kenneth.

Where is Kenneth Russell located?

Kenneth Russell practices at 3D Marine Raider Battalion, Camp Lejeune, NC 28546. The listed phone number is (360) 808-1590.

What is Kenneth Russell's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Kenneth Russell was last updated on May 31, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.