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General NPI Number Information
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NPI Number | 1235839937
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Entity Type | Individual
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Provider Name | KEVIN C ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 1800 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89102-2386
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Country | US
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Telephone | 703-383-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 243 COUNTRY CREEK WAY
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City | PALMYRA
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State | VA
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Zip | 22963-6238
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Country | US
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Telephone | 757-897-8938
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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