Provider Demographics
NPI:1801933320
Name:DIETRICH, KEVIN JOHN (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:DIETRICH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:832-717-4083
Mailing Address - Fax:832-422-2500
Practice Address - Street 1:4002 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4405
Practice Address - Country:US
Practice Address - Phone:832-717-4083
Practice Address - Fax:281-655-5234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251C00000X, 251J00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care