Individual
KAVEN MEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
319 S 17TH ST STE 418, OMAHA, NE 68102-2016
(402) 999-9063
Mailing address
5001 SPENCER ST, OMAHA, NE 68104-3564
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
NE
Other
Enumeration date
04/29/2025
Last updated
04/29/2025
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