MEDICARE: ASHLEY MCKENDALL NP

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	363LP2300X	Primary Care Nurse Practitioner	291628	AZ
2	163WX0800X	Orthopedic Registered Nurse	RN210369	AZ
3	363LF0000X	Family Nurse Practitioner	291628	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	291628	AZ

General Provider Information

NPI Number	:	1124744396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MCKENDALL NP

Provider Business Mailing Address
First Line	:	6219 W ALTADENA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-3203
Country	:	US
Telephone Number	:	808-673-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 W THUNDERBIRD RD STE B8
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4655
Country	:	US
Telephone Number	:	808-673-0171
Fax Number	:

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

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	06/13/2026

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