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General NPI Number Information
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NPI Number | 1881358414
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Entity Type | Individual
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Provider Name | KENADEY ROSE DAHLENBURG PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 112 E LUELLEN RD
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City | HINTON
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State | OK
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Zip | 73047-9524
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Country | US
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Telephone | 833-274-4174
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Fax | 833-274-4178
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Provider Business Mailing Address
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Address Line | 12095 COUNTY ROAD 1060
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City | HINTON
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State | OK
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Zip | 73047-9554
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Country | US
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Telephone | 405-368-7831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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