Provider Demographics
NPI:1740510197
Name:STEPHENS, KEVIN (RN)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N CROMWELL RD APT E6
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3842
Mailing Address - Country:US
Mailing Address - Phone:928-814-4101
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:928-814-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194050163WE0003X, 163WC0200X, 163WC1600X
GA8607146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development