Provider Demographics
NPI:1548007495
Name:KEVIN XUEREB PMHNP BC
Entity type:Organization
Organization Name:KEVIN XUEREB PMHNP BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XUEREB
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP BC
Authorized Official - Phone:917-359-0193
Mailing Address - Street 1:1885 HYLAN BLVD # 1179
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2110
Mailing Address - Country:US
Mailing Address - Phone:917-359-0193
Mailing Address - Fax:
Practice Address - Street 1:12 DONALD PLACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:917-359-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty