MEDICARE: KENDRA LEIGH SKAGGS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	71016610A	IN
2	363LW0102X	Women's Health Nurse Practitioner	4015511	KY

General Provider Information

NPI Number	:	1841043668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LEIGH SKAGGS NP

Provider Business Mailing Address
First Line	:	1319 DUNCAN AVE
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3759
Country	:	US
Telephone Number	:	812-283-2308
Fax Number	:

Provider Business Practice Location Address
First Line	:	642 BAXTER AVE APT 318
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1992
Country	:	US
Telephone Number	:	502-291-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	06/30/2026

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