Healthcare Provider Details

I. General information

NPI: 1083257695
Provider Name (Legal Business Name): KEVA SWOPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

8570 POLO CLUB DR APT U606
MERRILLVILLE IN
46410-8843
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4740
  • Fax:
Mailing address:
  • Phone: 219-648-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28226263A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number71009878A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number71009878A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number71009878A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71009878A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: