Provider Demographics
NPI:1912953597
Name:SPRINGER, KEVIN DEAN (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEAN
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9280 W SUNSET RD STE 426
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4862
Practice Address - Country:US
Practice Address - Phone:702-688-8110
Practice Address - Fax:702-891-5080
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000699363LF0000X
NVAPN000699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912953597Medicaid
NV100509474Medicaid
NVAPRN000699OtherSTATE LICENSE
NVDH899XMedicare PIN