Individual
MR. KEVIN J. PRATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
105 VALLEY WEST DR, SUITE 100, WEST DES MOINES, IA 50265-3902
(515) 223-4368
(515) 453-2368
Mailing address
105 VALLEY WEST DR, SUITE 100, WEST DES MOINES, IA 50265-3902
(515) 223-4368
(515) 453-2368
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001453
IA
363AS0400X
Surgical Physician Assistant
001453
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB2608010
MEDICARE PTAN
IA
01
—
IB2609013
MEDICARE PTAN
IA
01
—
IB2610005
MEDICARE PTAN
IA
01
—
IB2878003
MEDICARE PTAN
IA
Enumeration date
11/08/2005
Last updated
06/08/2015
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