Healthcare Provider Details

I. General information

NPI: 1891610515
Provider Name (Legal Business Name): KEVIN ANTHONY BRAGG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EDGEWOOD ST NE APT 220
WASHINGTON DC
20017-3344
US

IV. Provider business mailing address

1305 SAVANNAH ST SE APT 201
WASHINGTON DC
20032-5040
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-3837
  • Fax:
Mailing address:
  • Phone: 202-460-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: