Active NPI
Kevin Trahan, IDMT
- Independent Duty Corpsman
- Atlantic Beach, FL
National Provider Identifier
1598744021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 4200 Ocean St
Atlantic Beach, FL 32233-2416 - Phone
- (904) 564-7581
- NPI assigned
- Jan 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | |||
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
4200 Ocean St
Atlantic Beach, FL 32233-2416
Mailing address
4200 Ocean St
Atlantic Beach, FL 32233-2416
Phone (904) 564-7581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710I1003X | Other | FL | IDMT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1598744021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 OCEAN ST",
"city": "ATLANTIC BEACH",
"state": "FL",
"postal_code": "322332416",
"telephone_number": "904-564-7581",
"fax_number": "904-564-7583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 OCEAN ST",
"city": "ATLANTIC BEACH",
"state": "FL",
"postal_code": "322332416",
"telephone_number": "904-564-7581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAHAN",
"first_name": "KEVIN",
"credential": "IDMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-12",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": false
},
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDMT",
"identifier": "1710I1003X",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlantic Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.