Provider Demographics
NPI:1417511353
Name:ALVAREZ, KENNETHA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KENNETHA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-5205
Mailing Address - Country:US
Mailing Address - Phone:409-892-1924
Mailing Address - Fax:
Practice Address - Street 1:8205 LAKE POWELL DR
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5654
Practice Address - Country:US
Practice Address - Phone:409-332-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily