Provider Demographics
NPI:1932881455
Name:STEMBAUGH-REYES, KEVIN (NAC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:STEMBAUGH-REYES
Suffix:
Gender:M
Credentials:NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-3510
Mailing Address - Country:US
Mailing Address - Phone:509-321-9050
Mailing Address - Fax:
Practice Address - Street 1:10410 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3510
Practice Address - Country:US
Practice Address - Phone:509-321-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC61179577374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide