Healthcare Provider Details

I. General information

NPI: 1053368118
Provider Name (Legal Business Name): KEVIN K NASSERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 COLUMBINE DR
HOLTON KS
66436-8824
US

IV. Provider business mailing address

1110 COLUMBINE DR
HOLTON KS
66436-8824
US

V. Phone/Fax

Practice location:
  • Phone: 785-364-2116
  • Fax:
Mailing address:
  • Phone: 785-364-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0035851
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number04-35729
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: