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Individual
R KENT VANDERGRIFF
Active
Individual
R KENT VANDERGRIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
631043
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280002101
—
TX
01
—
835N41
BCBS
TX
01
—
TIN PLUS 042
TRICARE
TX
Enumeration date
12/08/2010
Last updated
10/14/2014
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