Healthcare Provider Details

I. General information

NPI: 1841337201
Provider Name (Legal Business Name): KEVIN STECKLINE RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COMFORT WAY STE 1
LEXINGTON VA
24450-3788
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-3381
  • Fax: 540-463-3477
Mailing address:
  • Phone: 540-463-3381
  • Fax: 540-463-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007104
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: