Provider Demographics
NPI:1154340099
Name:KENDALL, CAROL A (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KENDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-326-1347
Practice Address - Street 1:67 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285-1150
Practice Address - Country:US
Practice Address - Phone:760-376-2276
Practice Address - Fax:760-376-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1262363LF0000X
CANP15336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03673ZMedicare ID - Type Unspecified
Q33700Medicare UPIN