Provider Demographics
NPI:1831520758
Name:MADONDO, KEVIN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MADONDO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 SWAMP LEANNA RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-7752
Mailing Address - Country:US
Mailing Address - Phone:615-569-4888
Mailing Address - Fax:
Practice Address - Street 1:1034 N HIGHLAND AVE STE D
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2463
Practice Address - Country:US
Practice Address - Phone:615-569-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 343900000X, 347C00000X, 251B00000X
TN36697363L00000X
CA95030734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner