Provider Demographics
NPI:1801394630
Name:FLOWERS, KEVIN WINSTON-IVY JR
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:WINSTON-IVY
Last Name:FLOWERS
Suffix:JR
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 1:2781 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1416
Mailing Address - Country:US
Mailing Address - Phone:702-986-4224
Mailing Address - Fax:
Practice Address - Street 1:2781 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-1416
Practice Address - Country:US
Practice Address - Phone:702-986-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician