Healthcare Provider Details

I. General information

NPI: 1598215154
Provider Name (Legal Business Name): KEVIN BARBER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 N RANCHO SUITE 105
LAS VEGAS NV
89130
US

IV. Provider business mailing address

5840 BARBOSA DR UNIT 9
NORTH LAS VEGAS NV
89031-4151
US

V. Phone/Fax

Practice location:
  • Phone: 702-432-6463
  • Fax:
Mailing address:
  • Phone: 702-412-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number225C00000X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: