Provider Demographics
NPI:1194128579
Name:DARNELL, KEVIN DEAN I (LMT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DEAN
Last Name:DARNELL
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 SW VARNS ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8174
Mailing Address - Country:US
Mailing Address - Phone:503-442-9349
Mailing Address - Fax:
Practice Address - Street 1:7155 SW VARNS ST
Practice Address - Street 2:SUITE 214
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8174
Practice Address - Country:US
Practice Address - Phone:503-442-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMA 18971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist