Provider Demographics
NPI:1629053830
Name:TARVER, KENTON STEPHEN (AUD)
Entity Type:Individual
Prefix:
First Name:KENTON
Middle Name:STEPHEN
Last Name:TARVER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:727-398-5728
Mailing Address - Fax:727-398-4914
Practice Address - Street 1:8200 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 340
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777
Practice Address - Country:US
Practice Address - Phone:727-398-5728
Practice Address - Fax:727-398-4914
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1318231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9133OtherBCBS
FL33023OtherMEDICARE GROUP #
FLS9133OtherBCBS