Provider Demographics
NPI:1881623536
Name:KEVILLE, WORTHINGTON S III (PA-C)
Entity type:Individual
Prefix:MR
First Name:WORTHINGTON
Middle Name:S
Last Name:KEVILLE
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST STE E2200
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-978-7808
Mailing Address - Fax:772-978-9320
Practice Address - Street 1:787 37TH ST STE E2200
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-978-7808
Practice Address - Fax:772-978-9320
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970025675OtherRAILROAD MEDICARE
FLS77509Medicare UPIN
FLE2363YMedicare PIN