Individual
MR. KENT WAYNE VANDEVENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002674
VA
363AM0700X
Medical Physician Assistant
621
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810026229
—
WV
Enumeration date
07/04/2006
Last updated
08/03/2016
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