Provider Demographics
NPI:1154619260
Name:SCANLON, KINDRA THERESA (FNP)
Entity type:Individual
Prefix:MS
First Name:KINDRA
Middle Name:THERESA
Last Name:SCANLON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4175
Mailing Address - Country:US
Mailing Address - Phone:360-952-4457
Mailing Address - Fax:360-828-7409
Practice Address - Street 1:650 N DEVINE RD STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6979
Practice Address - Country:US
Practice Address - Phone:360-952-4457
Practice Address - Fax:360-828-7409
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201141805RN163W00000X
OR201391900NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse