Provider Demographics
NPI:1093341406
Name:BROWN, KENDALL (PA-C, RD/LD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 NW 9TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1077
Mailing Address - Country:US
Mailing Address - Phone:405-772-4338
Mailing Address - Fax:
Practice Address - Street 1:535 NW 9TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1077
Practice Address - Country:US
Practice Address - Phone:405-772-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2482133V00000X
OK5322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered