Provider Demographics
NPI:1194537050
Name:GAINES, KELVIN
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:GAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 PRIMROSE PL APT 37
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2381
Mailing Address - Country:US
Mailing Address - Phone:614-515-0269
Mailing Address - Fax:
Practice Address - Street 1:4041 PRIMROSE PL APT 37
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2381
Practice Address - Country:US
Practice Address - Phone:614-515-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide