Provider Demographics
NPI:1699542316
Name:LEE, KENDALL JACKSON
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:JACKSON
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 WESTRAY DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3765
Mailing Address - Country:US
Mailing Address - Phone:614-869-7518
Mailing Address - Fax:
Practice Address - Street 1:6690 INVERNESS ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7742
Practice Address - Country:US
Practice Address - Phone:717-991-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVH6777536376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker