Individual
KENNETH STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
Mailing address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
(805) 540-3344
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
A102905
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A102905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A1029050
BLUE SHIELD PROVIDER NUMBER
CA
01
—
9136184
AETNA PROVIDER NUMBER
CA
01
—
A102905
MEDICAL BOARD LICENSE
CA
Enumeration date
07/18/2006
Last updated
05/05/2025
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