Provider Demographics
NPI:1164943197
Name:PULLINS, KEVIN ROSS (RDCS, BS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROSS
Last Name:PULLINS
Suffix:
Gender:M
Credentials:RDCS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PARK PL
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-6671
Mailing Address - Country:US
Mailing Address - Phone:325-212-5838
Mailing Address - Fax:
Practice Address - Street 1:605 PARK PL
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323
Practice Address - Country:US
Practice Address - Phone:325-212-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42772246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular