Individual
KEVIN T VICK
Active
Individual
KEVIN T VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5594772-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218512
ALTIUS
UT
01
—
78674
PEHP
UT
01
—
880917
DESERET MUTUAL
UT
01
—
TPRA09780
MOLINA
UT
Enumeration date
09/14/2006
Last updated
07/08/2007
Update your record
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