Provider Demographics
NPI:1831843044
Name:SANTOS, KEVIN PETER VERGEL DE DIOS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PETER VERGEL DE DIOS
Last Name:SANTOS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:2115 WAUNELL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4863
Mailing Address - Country:US
Mailing Address - Phone:903-830-0766
Mailing Address - Fax:
Practice Address - Street 1:703 E MARSHALL AVE STE 1001
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-753-7291
Practice Address - Fax:903-315-5000
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017594363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner