Healthcare Provider Details

I. General information

NPI: 1407312424
Provider Name (Legal Business Name): KEVIN AUSTIN RAPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

IV. Provider business mailing address

3101 FLAGSTONE LN APT 307
INDIAN TRAIL NC
28079-8434
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-4143
  • Fax:
Mailing address:
  • Phone: 435-740-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08834
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: