Provider Demographics
NPI:1578063087
Name:WESTMORELAND, KEVIN (RN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:WESTMORELAND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SANTA FE ST APT 104
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3448
Mailing Address - Country:US
Mailing Address - Phone:940-224-9196
Mailing Address - Fax:
Practice Address - Street 1:2010 SANTA FE ST APT 104
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-3448
Practice Address - Country:US
Practice Address - Phone:940-224-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse