Provider Demographics
NPI:1235485418
Name:GATI, KEVIN (LPN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GATI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 DEVON AVE
Mailing Address - Street 2:APT E1
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3652
Mailing Address - Country:US
Mailing Address - Phone:937-829-9215
Mailing Address - Fax:
Practice Address - Street 1:1370 DEVON AVE
Practice Address - Street 2:APT E1
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3652
Practice Address - Country:US
Practice Address - Phone:937-829-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148150164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse