Provider Demographics
NPI:1407246374
Name:GLOVER, KELVIN DARRYL JR
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:DARRYL
Last Name:GLOVER
Suffix:JR
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 1:2245 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3771
Mailing Address - Country:US
Mailing Address - Phone:702-351-5737
Mailing Address - Fax:702-877-5697
Practice Address - Street 1:2235 E FLAMINGO RD STE 404
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5197
Practice Address - Country:US
Practice Address - Phone:702-816-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner