MEDICARE: KENDALL MCCORMICK APRN-CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	R0098646	OK

General Provider Information

NPI Number	:	1033727615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL MCCORMICK APRN-CNM

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13313 N MERIDIAN AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8316
Country	:	US
Telephone Number	:	405-254-1757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	12/12/2025

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