MEDICARE: KEVIN MARQUEL HERRING

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1285286401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MARQUEL HERRING

Provider Business Mailing Address
First Line	:	1312 DANIELS COVE DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4358
Country	:	US
Telephone Number	:	407-860-8445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 DANIELS COVE DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4358
Country	:	US
Telephone Number	:	407-860-8445
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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