Healthcare Provider Details

I. General information

NPI: 1598059636
Provider Name (Legal Business Name): KEVIN ALAN KISSNER RN, NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAGNOLIA SPRINGS RD
TROUTVILLE VA
24175-5101
US

IV. Provider business mailing address

115 MAGNOLIA SPRINGS RD
TROUTVILLE VA
24175-5101
US

V. Phone/Fax

Practice location:
  • Phone: 540-966-2234
  • Fax:
Mailing address:
  • Phone: 540-966-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberE093004104
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number0001185682
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: