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Individual
MR. KEVIN J. WENTWORTH
Active
Individual
MR. KEVIN J. WENTWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002269
NY
363A00000X
Physician Assistant
2269
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149288
PREFERRED CARE
NY
Enumeration date
04/24/2007
Last updated
06/30/2023
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