Provider Demographics
NPI:1306840327
Name:PHILLIPS, KENDALL LEIGH (PA)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEIGH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:PHILLIPS
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1110 N LEE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2612
Mailing Address - Country:US
Mailing Address - Phone:405-230-9000
Mailing Address - Fax:405-230-9421
Practice Address - Street 1:1110 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2612
Practice Address - Country:US
Practice Address - Phone:405-230-9000
Practice Address - Fax:405-230-9421
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical