Healthcare Provider Details

I. General information

NPI: 1902752447
Provider Name (Legal Business Name): KENDRA NICOLE FEWELL-HARTLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 LEHMAN DR STE 5
COLORADO SPRINGS CO
80918-3418
US

IV. Provider business mailing address

8329 FREESTAR WAY
COLORADO SPRINGS CO
80925-9454
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-8989
  • Fax:
Mailing address:
  • Phone: 719-357-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002027112
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: