Provider Demographics
NPI:1497555759
Name:HAYWORTH, KEVIN RUSSELL (EMT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RUSSELL
Last Name:HAYWORTH
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 9TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2019
Mailing Address - Country:US
Mailing Address - Phone:406-293-3113
Mailing Address - Fax:
Practice Address - Street 1:307 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2037
Practice Address - Country:US
Practice Address - Phone:406-293-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT88015146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic