Mayberry, Kevin E.

Mayberry, Kevin E. is an sole proprietor health care provider with primary practice located at 650 Joel Dr , Fort Campbell KY 42223-5318. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Mayberry, Kevin E. can be contacted via phone (270) 798-3969.

Contact Information

Primary practice address
650 Joel Dr Fort Campbell KY 42223-5318
Phone: (270) 798-3969
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X

Profile Details

NPI number 1669780078
LBN Legal business name Mayberry, Kevin E.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2010
Last updated Jul 8th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669780078 NPPES
Tennessee Other PA0000003853 TENNESSEE STATE LICENSE

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