Provider Demographics
NPI:1386760510
Name:KUYKENDALL, HARRISON SHERMAN III (PA-C)
Entity type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:SHERMAN
Last Name:KUYKENDALL
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-0000
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-241-7575
Practice Address - Street 1:12550 HESPERIA ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-0000
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-241-7575
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52710Medicare UPIN