Provider Demographics
NPI:1699579094
Name:ANDERSON, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 LITTLE YORK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PREBLE
Mailing Address - State:NY
Mailing Address - Zip Code:13141-9725
Mailing Address - Country:US
Mailing Address - Phone:607-423-0945
Mailing Address - Fax:
Practice Address - Street 1:6186 LITTLE YORK LAKE RD
Practice Address - Street 2:
Practice Address - City:PREBLE
Practice Address - State:NY
Practice Address - Zip Code:13141-9725
Practice Address - Country:US
Practice Address - Phone:607-423-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer