Provider Demographics
NPI:1699315747
Name:HENGEVELD, KEVIN (DNP, RN, A-GNP)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HENGEVELD
Suffix:
Gender:M
Credentials:DNP, RN, A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAFAYETTE AVE SE STE 2045
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4692
Mailing Address - Country:US
Mailing Address - Phone:616-685-3098
Mailing Address - Fax:616-685-3095
Practice Address - Street 1:300 LAFAYETTE AVE SE STE 2045
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4692
Practice Address - Country:US
Practice Address - Phone:616-685-3098
Practice Address - Fax:616-685-3095
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704207506363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty