Provider Demographics
NPI:1144687690
Name:NORRIS, KEVIN RODRIQUEZ
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RODRIQUEZ
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COUNTRY CLUB LN APT 17H
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1728
Mailing Address - Country:US
Mailing Address - Phone:864-934-9782
Mailing Address - Fax:
Practice Address - Street 1:2315 N MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3880
Practice Address - Country:US
Practice Address - Phone:864-359-2324
Practice Address - Fax:704-540-8787
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator