Provider Demographics
NPI:1972972016
Name:KUYKENDALL, LAUREN EVA (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:EVA
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3043
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3043
Practice Address - Country:US
Practice Address - Phone:585-442-5320
Practice Address - Fax:585-442-5526
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical