Provider Demographics
NPI:1649580523
Name:CUMMINGS, KEVIN JESUS
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JESUS
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 CLEARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6363
Mailing Address - Country:US
Mailing Address - Phone:775-229-6826
Mailing Address - Fax:775-622-4837
Practice Address - Street 1:4408 CLEARWOOD DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6363
Practice Address - Country:US
Practice Address - Phone:775-229-6826
Practice Address - Fax:775-622-4837
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst