Provider Demographics
NPI:1285124560
Name:KENDALL, ROXAN A (APRN)
Entity type:Individual
Prefix:MRS
First Name:ROXAN
Middle Name:A
Last Name:KENDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N RIVERVIEW ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4265
Mailing Address - Country:US
Mailing Address - Phone:316-616-1055
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4265
Practice Address - Country:US
Practice Address - Phone:316-616-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-128966-111163W00000X
KS78392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201223540AMedicaid