Provider Demographics
NPI:1336148907
Name:MEYER, KENDRA LEIGH (PAC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:MEYER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEATTY LN
Mailing Address - Street 2:
Mailing Address - City:SCENERY HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15360-1537
Mailing Address - Country:US
Mailing Address - Phone:247-884-5159
Mailing Address - Fax:
Practice Address - Street 1:500 W BERKELEY ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5514
Practice Address - Country:US
Practice Address - Phone:724-430-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002709L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA19491Medicare ID - Type Unspecified
P66225Medicare UPIN