Healthcare Provider Details

I. General information

NPI: 1952959496
Provider Name (Legal Business Name): MR. PATRICK DONEL KUYKENDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 BRAESWOOD PARK DR. APT 239
HOUSTON TX
77030
US

IV. Provider business mailing address

2255 BRAESWOOD PARK DR. APT 239
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 713-553-5168
  • Fax:
Mailing address:
  • Phone: 713-553-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: