Provider Demographics
NPI:1104406438
Name:NAVARRETE, KEVIN (NP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NAVARRETE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 PERRINTON TRL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8922
Mailing Address - Country:US
Mailing Address - Phone:253-332-1344
Mailing Address - Fax:
Practice Address - Street 1:4295 PERRINTON TRL
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8922
Practice Address - Country:US
Practice Address - Phone:253-332-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily