Provider Demographics
NPI:1508230517
Name:MYERS, KEVIN (NP, MSN, ACRN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:NP, MSN, ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CRESSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1264
Mailing Address - Country:US
Mailing Address - Phone:856-873-7666
Mailing Address - Fax:
Practice Address - Street 1:1193R N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2135
Practice Address - Country:US
Practice Address - Phone:339-987-5552
Practice Address - Fax:339-987-5554
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259976363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care