Provider Demographics
NPI:1427036193
Name:DEAN, KURTIS LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:LEE
Last Name:DEAN
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 1:6703 ORDSALL ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5559
Mailing Address - Country:US
Mailing Address - Phone:703-971-7339
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVE
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20332-0001
Practice Address - Country:US
Practice Address - Phone:202-404-3603
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical