MEDICARE: DR. KEVIN DENNIE SR. DMIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	LCMFT0487011216	FL

General Provider Information

NPI Number	:	1427595834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DENNIE SR. DMIN

Provider Business Mailing Address
First Line	:	7305 TWELVE OAKS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7305 TWELVE OAKS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2271
Country	:	US
Telephone Number	:	813-270-4705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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