Healthcare Provider Details

I. General information

NPI: 1275470320
Provider Name (Legal Business Name): KEVIN ARTHUR RAVENEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 ROXBURY DR
NORTH CHARLESTON SC
29418-2041
US

IV. Provider business mailing address

5432 ROXBURY DR
NORTH CHARLESTON SC
29418-2041
US

V. Phone/Fax

Practice location:
  • Phone: 843-259-2982
  • Fax:
Mailing address:
  • Phone: 843-259-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: