Provider Demographics
NPI:1215027297
Name:MCDERMOTT, KEVIN BARRY (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BARRY
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1438
Mailing Address - Country:US
Mailing Address - Phone:203-757-6592
Mailing Address - Fax:
Practice Address - Street 1:74 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1438
Practice Address - Country:US
Practice Address - Phone:203-757-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE44558163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator