Healthcare Provider Details

I. General information

NPI: 1548195878
Provider Name (Legal Business Name): KENDI ASHMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SE PARKER DR
WAUKEE IA
50263-8391
US

IV. Provider business mailing address

655 SE PARKER DR
WAUKEE IA
50263-8391
US

V. Phone/Fax

Practice location:
  • Phone: 515-421-5661
  • Fax:
Mailing address:
  • Phone: 515-421-5661
  • Fax: 515-421-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG191742
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: