Provider Demographics
NPI:1619797578
Name:DORSEY, KEVIN D
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:DORSEY
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 1:3301 OLD STERLINGTON RD APT 58
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2660
Mailing Address - Country:US
Mailing Address - Phone:832-350-9336
Mailing Address - Fax:
Practice Address - Street 1:3301 OLD STERLINGTON RD APT 58
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2660
Practice Address - Country:US
Practice Address - Phone:832-350-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator