Provider Demographics
NPI:1932163862
Name:VINING, KEVIN A (BS, MHA, ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:VINING
Suffix:
Gender:M
Credentials:BS, MHA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BULLS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06785-1118
Mailing Address - Country:US
Mailing Address - Phone:860-927-3539
Mailing Address - Fax:860-927-1161
Practice Address - Street 1:40 BULLS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH KENT
Practice Address - State:CT
Practice Address - Zip Code:06785-1118
Practice Address - Country:US
Practice Address - Phone:860-927-3539
Practice Address - Fax:860-927-1161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program