Provider Demographics
NPI:1982752440
Name:DEUTSCHE, KEVIN R (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:DEUTSCHE
Suffix:
Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:555 PETALUMA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4225
Mailing Address - Country:US
Mailing Address - Phone:707-823-7602
Mailing Address - Fax:707-823-7625
Practice Address - Street 1:555 PETALUMA AVE STE B
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4225
Practice Address - Country:US
Practice Address - Phone:707-823-7602
Practice Address - Fax:707-823-7625
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011652363A00000X
CAPA21817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant