Healthcare Provider Details

I. General information

NPI: 1245191949
Provider Name (Legal Business Name): JOLENE PIPER KENDALL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E SCHNEIDMILLER AVE
POST FALLS ID
83854-7065
US

IV. Provider business mailing address

5010 W RICHLAND LN
SPOKANE WA
99224-6906
US

V. Phone/Fax

Practice location:
  • Phone: 208-773-8111
  • Fax:
Mailing address:
  • Phone: 509-413-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: