Kent Wayne Vandevender, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002674 Issued in VA

Practice address

103 Valley Center Dr
Staunton, VA 24401-5080

Phone

(540) 332-8220

Fax

(540) 332-8385

NPI assigned

Jul 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pendleton Community Care Inc

  dba Harman Health Center

  • Clinical Medical Laboratory
  • Harman, WV
  • NPI 1437401643
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470182400000",
    "number": "1407886203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2500",
            "city": "STAUNTON",
            "state": "VA",
            "postal_code": "244022500",
            "telephone_number": "540-332-8220",
            "fax_number": "540-332-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 VALLEY CENTER DR",
            "city": "STAUNTON",
            "state": "VA",
            "postal_code": "244015080",
            "telephone_number": "540-332-8220",
            "fax_number": "540-332-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVENDER",
        "first_name": "KENT",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2016-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "621",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810026229",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley Community Services Board
• Valley Family Wellness and Chiropractic
• Valley Restoration Counseling Group, PLC (Tasso Counseling)
• Julia Reed Van Ness
• Matthew Vanden Hoek, MD
• Joanne Custer Vansiclen I, C.O.T.A.L.
• Brook-Lynn Tyree Velvin, LPC
• Verona Chiropractic PC (Robson Wellness & Chiropractic)
• Tonia Kendall Vinecombe, LPC
• Virginia CVS Pharmacy LLC (CVS Pharmacy #01557)

• Medical Physician Assistant in Staunton, VA
• Providers in Staunton, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.