Provider Demographics
NPI:1215902788
Name:KENDALL, STEPHANIE MICHELE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MICHELE
Other - Last Name:CREEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:601 W MAPLE AVE STE 503
Mailing Address - Street 2:NORTHWEST ANESTHESIOLOGY ASSOCIATES
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5376
Mailing Address - Country:US
Mailing Address - Phone:479-751-3722
Mailing Address - Fax:479-751-1099
Practice Address - Street 1:601 W MAPLE AVE STE 503
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5376
Practice Address - Country:US
Practice Address - Phone:479-751-3722
Practice Address - Fax:479-751-1099
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11874367500000X
ARC002663367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168887001Medicaid
AR168887001Medicaid