Provider Demographics
NPI:1932854106
Name:KIRKENDALL, DAWN KAY
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:KAY
Last Name:KIRKENDALL
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:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-0656
Mailing Address - Country:US
Mailing Address - Phone:541-295-7352
Mailing Address - Fax:
Practice Address - Street 1:6889 BEAR BRANCH RD
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9617
Practice Address - Country:US
Practice Address - Phone:541-295-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty