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General NPI Number Information
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NPI Number | 1124563812
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Entity Type | Individual
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Provider Name | KEN BEVIS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 81-6587 MAMALAHOA HWY SUITE C-301
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City | KEALAKEKUA
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State | HI
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Zip | 96750
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Country | US
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Telephone | 808-769-5212
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Fax | 808-769-5213
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Provider Business Mailing Address
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Address Line | PO BOX 650
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City | KEALAKEKUA
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State | HI
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Zip | 96750-0650
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Country | US
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Telephone | 808-769-5212
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Fax | 808-769-5213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 10023
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License Number State | HI
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