Healthcare Provider Details

I. General information

NPI: 1174045439
Provider Name (Legal Business Name): TONYA KENDRICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST
CHERRYVALE KS
67335-1332
US

IV. Provider business mailing address

PO BOX 360
NEODESHA KS
66757-0360
US

V. Phone/Fax

Practice location:
  • Phone: 620-336-2131
  • Fax: 620-336-2237
Mailing address:
  • Phone: 620-325-2611
  • Fax: 620-325-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99787
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13111838092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: