Provider Demographics
NPI:1174342976
Name:JULIEN, KEVIN A
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:JULIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2600
Mailing Address - Country:US
Mailing Address - Phone:804-338-8482
Mailing Address - Fax:
Practice Address - Street 1:3301 GORDON DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2600
Practice Address - Country:US
Practice Address - Phone:804-338-8482
Practice Address - Fax:804-895-7877
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA100892602343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)