Provider Demographics
NPI:1811072515
Name:VERNON, KEVIN D (MSPT, CSCS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:VERNON
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 W PRENTICE PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6213
Mailing Address - Country:US
Mailing Address - Phone:720-924-5878
Mailing Address - Fax:
Practice Address - Street 1:6825 S GALENA ST
Practice Address - Street 2:#250
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3715
Practice Address - Country:US
Practice Address - Phone:720-924-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800862Medicare PIN