Healthcare Provider Details

I. General information

NPI: 1801081658
Provider Name (Legal Business Name): KENDA L DEAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENDA L NICHOLS ARNP

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/07/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S BRIDGE BLVD
GRANDFIELD OK
73546
US

IV. Provider business mailing address

PO BOX 475
GRANDFIELD OK
73546-0475
US

V. Phone/Fax

Practice location:
  • Phone: 580-560-5715
  • Fax: 580-560-5735
Mailing address:
  • Phone: 580-560-5715
  • Fax: 580-560-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR0075098
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133894
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75098
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: