Provider Demographics
NPI:1598059636
Name:KISSNER, KEVIN ALAN (RN, NREMT-P)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:KISSNER
Suffix:
Gender:M
Credentials:RN, NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAGNOLIA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-5101
Mailing Address - Country:US
Mailing Address - Phone:540-966-2234
Mailing Address - Fax:
Practice Address - Street 1:115 MAGNOLIA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TROUTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24175-5101
Practice Address - Country:US
Practice Address - Phone:540-966-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE093004104146L00000X
VA0001185682163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic