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General NPI Number Information
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NPI Number | 1184643629
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Entity Type | Individual
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Provider Name | KENNETH STEVENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 3268 WATERSTONE AVE
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City | HENDERSON
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State | NV
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Zip | 89044-1867
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Country | US
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Telephone | 815-378-8514
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Fax |
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Provider Business Mailing Address
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Address Line | 3268 WATERSTONE AVE
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City | HENDERSON
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State | NV
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Zip | 89044-1867
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Country | US
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Telephone | 815-378-8514
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Fax | 805-540-3344
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | A102905
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A102905
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License Number State | CA
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