Provider Demographics
NPI:1598406589
Name:MANURS, KELVIN (PRS)
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:
Last Name:MANURS
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-8218
Mailing Address - Country:US
Mailing Address - Phone:571-245-4568
Mailing Address - Fax:
Practice Address - Street 1:8220 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-8218
Practice Address - Country:US
Practice Address - Phone:571-245-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
VA0735000416175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist