Healthcare Provider Details

I. General information

NPI: 1972972016
Provider Name (Legal Business Name): LAUREN EVA KUYKENDALL MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN HALL PA

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE SUITE 350
ROCHESTER NY
14621-3043
US

IV. Provider business mailing address

1415 PORTLAND AVE SUITE 350
ROCHESTER NY
14621-3043
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-5320
  • Fax: 585-442-5526
Mailing address:
  • Phone: 585-442-5320
  • Fax: 585-442-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number021503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: