Provider Demographics
NPI:1780948984
Name:PRYOR, KEVIN GERARD (RN BSN)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GERARD
Last Name:PRYOR
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOUNT COOK AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2022
Mailing Address - Country:US
Mailing Address - Phone:631-736-5603
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNT COOK AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2022
Practice Address - Country:US
Practice Address - Phone:631-736-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589840-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse