Provider Demographics
NPI:1790401990
Name:KEMP, STEVEN (FNP APPLICANT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KEMP
Suffix:
Gender:M
Credentials:FNP APPLICANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1833
Mailing Address - Country:US
Mailing Address - Phone:928-379-0839
Mailing Address - Fax:
Practice Address - Street 1:2255 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-1833
Practice Address - Country:US
Practice Address - Phone:928-379-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARN095853163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice