Provider Demographics
NPI:1730239476
Name:ROJAS, KEVIN (PHYSICAN ASSISTANT P)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ROJAS
Suffix:
Gender:M
Credentials:PHYSICAN ASSISTANT P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HIXON CIR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-2245
Mailing Address - Country:US
Mailing Address - Phone:817-360-5745
Mailing Address - Fax:
Practice Address - Street 1:438 E VANN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-278-1650
Practice Address - Fax:423-278-1667
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1730239476OtherNPI
TN3370042Medicaid
TN1730239476OtherNPI