Healthcare Provider Details

I. General information

NPI: 1871415182
Provider Name (Legal Business Name): KENDALL WILLIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDALL GIVENS

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 METROPOLITAN BLVD STE 302
TALLAHASSEE FL
32312-2536
US

IV. Provider business mailing address

198 POST OAK CIR
MONTICELLO FL
32344-6794
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-0100
  • Fax:
Mailing address:
  • Phone: 850-868-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: