Healthcare Provider Details

I. General information

NPI: 1871246140
Provider Name (Legal Business Name): KENDALL BRUNS WHIGHAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDALL ELAINE BRUNS FNP-C

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 OLD SHELL RD
MOBILE AL
36608-1912
US

IV. Provider business mailing address

4402 OLD SHELL RD
MOBILE AL
36608-1912
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-162559
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: