Provider Demographics
NPI:1912953597
Name:SPRINGER, KEVIN DEAN (APRN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DEAN
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:100 N GREEN VALLEY PKWY STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6392
Practice Address - Country:US
Practice Address - Phone:702-269-9995
Practice Address - Fax:702-944-4056
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000699363LF0000X
NVAPN000699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN000699OtherSTATE LICENSE
NV1912953597Medicaid
NV100509474Medicaid
NVDH899XMedicare PIN