Provider Demographics
NPI:1457083057
Name:OWENS, KELVIN LAMAR
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:LAMAR
Last Name:OWENS
Suffix:
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 1:5501 N 19TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2450
Mailing Address - Country:US
Mailing Address - Phone:480-409-0963
Mailing Address - Fax:
Practice Address - Street 1:5501 N 19TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2450
Practice Address - Country:US
Practice Address - Phone:480-409-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist