Provider Demographics
NPI:1770841801
Name:WHITMON, KEVIN TYRONE
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TYRONE
Last Name:WHITMON
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 1:130 RANDOLPH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1126
Mailing Address - Country:US
Mailing Address - Phone:202-232-6128
Mailing Address - Fax:
Practice Address - Street 1:130 RANDOLPH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1126
Practice Address - Country:US
Practice Address - Phone:202-232-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide