Healthcare Provider Details

I. General information

NPI: 1932881455
Provider Name (Legal Business Name): KEVIN STEMBAUGH-REYES CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N ARGONNE RD
SPOKANE VALLEY WA
99212-2657
US

IV. Provider business mailing address

1227 N ARGONNE RD
SPOKANE VALLEY WA
99212-2657
US

V. Phone/Fax

Practice location:
  • Phone: 509-505-5315
  • Fax: 509-530-2837
Mailing address:
  • Phone: 509-505-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberNC61179577
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC61179577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: