KEVIN J. CREEDON (NPI# 1851440531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851440531 |
| Entity Type | Individual |
| Full Name | KEVIN J. CREEDON |
| Credential | APRN |
| Practice Address |
1100 Wilford Hall Loop Bldg 4554 Jbsa Lackland TX 78236 |
| Mailing Address |
2624 Leebernard Chavis Ct Jbsa Lackland TX 78236-1052 |
| Practice Telephone | 2103959127 |
| Mailing Telephone | 2103959127 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2018-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R230746 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
SP009318 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN502279L | PA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063951952 | Kevin Creedon | Nurse Practitioner | 5705 Monclova Rd Ste 201, Maumee, OH 43537-1877 | 2017-02-13 |
| Street Address |
1100 WILFORD HALL LOOP BLDG 4554 |
| City | JBSA LACKLAND |
| State | TX |
| Zip Code | 78236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176266 | Peter S Scholler | Nurse Practitioner | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 | 2005-06-28 |
| 1376144428 | Steven Hilton | Physician Assistant | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-11-05 |
| 1235759077 | Courtney Kelly | Dentist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-22 |
| 1326667783 | Shreena Reddy | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-15 |
| 1114556685 | Magin Day | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-06 |
| 1346879038 | Caitlin Gonsolin | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-04-03 |
| 1497383756 | Jerry Andrew Peer | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-03-31 |
| 1083241103 | Brian Patrick Staak | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-03-26 |
| 1902438583 | Andrew Kim | Physical Therapist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2020-02-11 |
| 1326694845 | Ross Stanley | Dentist | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | 2019-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047363 | Arnoldo Arturo Gonzalez Jr. | Specialist/Technologist | 1033 Truemper St, Lackland Afb, TX 78236 | 2020-03-06 |
| 1023643343 | Meredith Grace Cockerell | Specialist/Technologist | W Military Drive, San Antonio, TX 78236 | 2020-03-06 |
| 1578120598 | Hali Rashelle Hall | Dentist | 1615 Truemper St, Blg 6418, Attn: 59ds/sgdn, Jbsa Lackland, TX 78236 | 2019-05-24 |
| 1952967077 | Paul Fianza Boseman | Nurse Practitioner | 1106 Wilford Hall Loop, San Antonio, TX 78236 | 2019-05-14 |
| 1689161978 | Kelly Jones Buckshire | Dentist | Dunn Dental Clinic, 1615 Truemper Rd, San Antonio, TX 78236 | 2018-04-23 |
| 1902308570 | Roger Louis Farney | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg. 4554, Jbsa Lackland Afb, TX 78236 | 2018-02-28 |
| 1568916856 | Thomas Maxwell Woolf | Dentist | 1100 Wilford Hall Ambulatory Surgical Center, Lackland Afb, TX 78236 | 2016-08-04 |
| 1831544956 | Michael Veronneau | Student in an Organized Health Care Education/Training Program | 59 Mdw/ge 1100 Wilford Hall Loop, Bldg. 4554, Jbsa Lackland, TX 78236 | 2016-04-26 |
| 1376906958 | David Kephart Jr. | General Practice | 1100 Wilford Hall Loop Bldg 4454, Jbsa Lackland, TX 78236 | 2016-04-01 |
| 1184084089 | Olivia Arballo | Dermatology | Wilford Hall Asc, Attn: Dept of Dermatology, 1100 Wilford Hall Loop Bldg 4554, Jbsa-lackland, TX 78236 | 2016-03-04 |
| Find all providers in zip 78236 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267555 | Rachel Broussard | Nurse Practitioner | 1100 Wilford Hall Loop, Bldg 4554, Attn: 59 Mdw/sghc, Jbsa Lackland, TX 78236 | 2017-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537857 | Julius Abam | Nurse Practitioner | 634 Rustic Trl, Midlothian, TX 76065-2267 | 2020-10-30 |
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| 1821698754 | Christienne Felice Solis Callasan | Nurse Practitioner | 1010 Palos Verdes Blvd, Arlington, TX 76017-1780 | 2020-10-29 |
| 1932709201 | Aftercare, Pllc | Nurse Practitioner | 2000 Crawford St Ste 1221, Houston, TX 77002-9000 | 2020-10-27 |
| 1497355929 | Hector Medellin IIi | Nurse Practitioner | 6014 County Road 4068, Kemp, TX 75143-2600 | 2020-10-26 |
| 1639778947 | Aj Psychiatry Pllc | Nurse Practitioner | 1920 N Coit Rd Ste 219, Richardson, TX 75080-2832 | 2020-10-19 |
| 1154929735 | Valerie Michelle Vaughn-smith | Nurse Practitioner | 3105 Rockbrook Dr, Kilgore, TX 75662-2251 | 2020-10-15 |
| 1700483468 | Knd Behavioural Health Clinic | Nurse Practitioner | 103 Herrington Dr, Mansfield, TX 76063-7615 | 2020-10-06 |
| 1184231805 | Tihana Sladic | Nurse Practitioner | 1515 S Capital of Texas Hwy Ste 300&301, Austin, TX 78746-6579 | 2020-09-27 |
| 1679189369 | Charity Chioma Durant | Nurse Practitioner | 2310 Echo Ct, Rowlett, TX 75088-1534 | 2020-09-18 |
| Find all providers with the same taxonomy | ||||
| City | JBSA LACKLAND |
| Zip Code | 78236 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.