Healthcare Provider Details

I. General information

NPI: 1730623570
Provider Name (Legal Business Name): JAMES KENDALL PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

IV. Provider business mailing address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-8686
  • Fax: 573-874-8608
Mailing address:
  • Phone: 573-874-8686
  • Fax: 573-874-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2016042777
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: