MEDICARE: JUSTIN KENT PA-C

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

General Provider Information

NPI Number	:	1497353627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN KENT PA-C

Provider Business Mailing Address
First Line	:	4521 NANTUCKET CLIPPER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3492
Country	:	US
Telephone Number	:	702-510-7370
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 NANTUCKET CLIPPER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3492
Country	:	US
Telephone Number	:	702-510-7370
Fax Number	:

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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Directions to “ JUSTIN KENT PA-C” Practice Location

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