Provider Demographics
NPI:1225151335
Name:WARD, KEVIN G (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:WARD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MASALIN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-5540
Mailing Address - Country:US
Mailing Address - Phone:207-763-4559
Mailing Address - Fax:
Practice Address - Street 1:10 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5735
Practice Address - Country:US
Practice Address - Phone:207-626-7250
Practice Address - Fax:207-621-1154
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER047006363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health