Provider Demographics
NPI:1790058220
Name:DEAS, KENNETH NELSON (PA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:NELSON
Last Name:DEAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:NELSON
Other - Last Name:DEAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:5630 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8784
Mailing Address - Country:US
Mailing Address - Phone:409-781-3899
Mailing Address - Fax:409-924-9786
Practice Address - Street 1:2601 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5222
Practice Address - Country:US
Practice Address - Phone:281-360-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant