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General NPI Number Information
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NPI Number | 1740749274
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Entity Type | Organization
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Legal Business Name | KENDALL ALTAFFER PMHNP PLLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 3305 NORTHLAND DR STE 210
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City | AUSTIN
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State | TX
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Zip | 78731-4988
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Country | US
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Telephone | 512-454-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 LOBELIA DR
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City | CEDAR PARK
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State | TX
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Zip | 78613-5706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | KENDALL KAYWORTH
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Credential | APRN
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Telephone | 254-716-1764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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