MEDICARE: KEVIN D KENT

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	103K00000X	Behavior Analyst	1-23-69972	FL
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154955946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D KENT

Provider Business Mailing Address
First Line	:	4715 CHARLES PARTIN DR
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-1243
Country	:	US
Telephone Number	:	857-500-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 CHARLES PARTIN DR
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-1243
Country	:	US
Telephone Number	:	857-500-3381
Fax Number	:

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

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	11/27/2024

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Directions to “ KEVIN D KENT ” Practice Location

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