Provider Demographics
NPI:1174363782
Name:KAYZER, DEVEON
Entity type:Individual
Prefix:
First Name:DEVEON
Middle Name:
Last Name:KAYZER
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 1:1808 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-2439
Mailing Address - Country:US
Mailing Address - Phone:317-762-9770
Mailing Address - Fax:
Practice Address - Street 1:1808 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-2439
Practice Address - Country:US
Practice Address - Phone:317-762-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant