Provider Demographics
NPI:1659846343
Name:MARTIN, KENT S
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:S
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NEMT PROVIDER
Mailing Address - Street 1:371 NETTLE RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-2653
Mailing Address - Country:US
Mailing Address - Phone:276-694-3892
Mailing Address - Fax:
Practice Address - Street 1:371 NETTLE RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-2653
Practice Address - Country:US
Practice Address - Phone:276-694-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT63350847172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver