Provider Demographics
NPI:1508431107
Name:NYABERA, KEVIN OTUNDO (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:OTUNDO
Last Name:NYABERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 HOPE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6767
Mailing Address - Country:US
Mailing Address - Phone:919-637-3524
Mailing Address - Fax:
Practice Address - Street 1:250 NASH MEDICAL ARTS MALL STE D
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1470
Practice Address - Country:US
Practice Address - Phone:252-451-2700
Practice Address - Fax:252-451-2702
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33001207Q00000X, 390200000X
NC2024-02979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty