Provider Demographics
NPI:1740903525
Name:CAMACHO, KEVAN ABEL (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:KEVAN
Middle Name:ABEL
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3970 W ANN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3852
Mailing Address - Country:US
Mailing Address - Phone:702-747-4799
Mailing Address - Fax:702-747-4667
Practice Address - Street 1:3970 W ANN RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3853
Practice Address - Country:US
Practice Address - Phone:702-747-4799
Practice Address - Fax:702-747-4667
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV827703363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care