Healthcare Provider Details

I. General information

NPI: 1891623690
Provider Name (Legal Business Name): KENDALL BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDALL SHOCKLEY

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 KEEFER LN
GROVE CITY OH
43123-7916
US

IV. Provider business mailing address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

V. Phone/Fax

Practice location:
  • Phone: 614-230-6183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: