Provider Demographics
NPI:1316088487
Name:BIVINS, KENNETH EARL (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EARL
Last Name:BIVINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1940 FEATHER RIVER BLVD
Mailing Address - Street 2:SUITE O
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5723
Mailing Address - Country:US
Mailing Address - Phone:530-534-5135
Mailing Address - Fax:530-532-0259
Practice Address - Street 1:1940 FEATHER RIVER BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5723
Practice Address - Country:US
Practice Address - Phone:530-534-5135
Practice Address - Fax:530-532-0259
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant