Healthcare Provider Details

I. General information

NPI: 1063033603
Provider Name (Legal Business Name): KEVIN PINTO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE 101
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE STE 101
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3232
  • Fax: 270-852-1600
Mailing address:
  • Phone: 270-683-3232
  • Fax: 270-852-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3014182
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: