Basic Information
| Provider Information | |||||||||
| NPI: | 1386076958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RALLS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 W INA RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5207847226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 W VALENCIA RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857466001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205730966 | ||||||||
| FaxNumber: | 5205733930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2013 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP5058 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.