Provider Demographics
NPI:1407856982
Name:THORN, KEVIN JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
Last Name:THORN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 W CHARLESTON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1998
Mailing Address - Country:US
Mailing Address - Phone:702-476-9999
Mailing Address - Fax:702-946-1343
Practice Address - Street 1:6990 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3119
Practice Address - Country:US
Practice Address - Phone:702-476-9999
Practice Address - Fax:702-946-1343
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA717363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP90742Medicare UPIN
NV37630Medicare ID - Type Unspecified