Provider Demographics
NPI:1851660138
Name:ALSTON, KEVIN RANDALL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RANDALL
Last Name:ALSTON
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 1:201 I ST SW # V816
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4267
Mailing Address - Country:US
Mailing Address - Phone:202-459-3824
Mailing Address - Fax:
Practice Address - Street 1:103 G ST SW APT B614
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4331
Practice Address - Country:US
Practice Address - Phone:202-940-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide