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NPI Code Detail

MEDICARE: KELVIN PREWITT

MEDICARE:   KELVIN  PREWITT
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1386073757
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELVIN PREWITT
Provider Business Mailing Address
First Line : 2504 CHAMBERS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3729
Country : US
Telephone Number : 702-517-0896
Fax Number : 702-432-6464
Provider Business Practice Location Address
First Line : 2504 CHAMBERS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3729
Country : US
Telephone Number : 702-517-0896
Fax Number : 702-432-6464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2013
Last Update Date : 11/06/2013

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Directions to “ KELVIN PREWITT ” Practice Location

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