Provider Demographics
NPI:1659374833
Name:VANHOY, KEVIN BRUCE (PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRUCE
Last Name:VANHOY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 OAK RIDGE FARM HWY
Mailing Address - Street 2:STE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7924
Mailing Address - Country:US
Mailing Address - Phone:704-658-0011
Mailing Address - Fax:
Practice Address - Street 1:798 OAK RIDGE FARM HWY
Practice Address - Street 2:STE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-7924
Practice Address - Country:US
Practice Address - Phone:704-658-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2751164AMedicare ID - Type Unspecified
NCS76844Medicare UPIN