Provider Demographics
NPI:1518291384
Name:ROUSH, KEVIN A (CST FA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:ROUSH
Suffix:
Gender:M
Credentials:CST FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2907
Mailing Address - Country:US
Mailing Address - Phone:307-277-3209
Mailing Address - Fax:307-472-1881
Practice Address - Street 1:2211 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2907
Practice Address - Country:US
Practice Address - Phone:307-277-3209
Practice Address - Fax:307-472-1881
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant