Provider Demographics
NPI:1003148636
Name:WORTH, KEVIN TRAVIS (RN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TRAVIS
Last Name:WORTH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 457 BOX 166
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09033-0002
Mailing Address - Country:US
Mailing Address - Phone:321-449-9080
Mailing Address - Fax:
Practice Address - Street 1:CMR 457
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033-9998
Practice Address - Country:US
Practice Address - Phone:0972-196-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 137390 1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOMedicare UPIN