MEDICARE: KEVIN LAVERNE MCNABB P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.0004657	CO

General Provider Information

NPI Number	:	1043203490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LAVERNE MCNABB P.A.

Provider Business Mailing Address
First Line	:	75 PRINTERS PKWY STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3142
Country	:	US
Telephone Number	:	719-300-8432
Fax Number	:	719-284-4635

Provider Business Practice Location Address
First Line	:	75 PRINTERS PKWY STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3142
Country	:	US
Telephone Number	:	402-559-4015
Fax Number	:	402-559-8210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	03/08/2023

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