Provider Demographics
NPI:1295149235
Name:CHADBURN, KEVIN S (ARNP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:CHADBURN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S 30TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3713
Mailing Address - Country:US
Mailing Address - Phone:509-972-1051
Mailing Address - Fax:509-972-4166
Practice Address - Street 1:5475 S 500 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6905
Practice Address - Country:US
Practice Address - Phone:800-880-3566
Practice Address - Fax:801-432-2670
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9303569367500000X
WAAP60506972367500000X
UT70000525-8901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered