Provider Demographics
NPI:1497166045
Name:SALAS, KEVIN EDWARD (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EDWARD
Last Name:SALAS
Suffix:
Gender:M
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 1:2013 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5078
Mailing Address - Country:US
Mailing Address - Phone:432-889-2977
Mailing Address - Fax:
Practice Address - Street 1:4410 N MIDKIFF RD STE D6
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:432-704-5607
Practice Address - Fax:432-704-5578
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily