Healthcare Provider Details

I. General information

NPI: 1598498842
Provider Name (Legal Business Name): KENDALL LEUFFEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 FISHBURN RD
HERSHEY PA
17033-2015
US

IV. Provider business mailing address

845 FISHBURN RD
HERSHEY PA
17033-2015
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8181
  • Fax:
Mailing address:
  • Phone: 717-531-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063664
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: