MEDICARE: KENDRA NICOLE FEWELL-HARTLING

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	124Q00000X	Dental Hygienist	DH.002027112	CO

General Provider Information

NPI Number	:	1902752447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA NICOLE FEWELL-HARTLING

Provider Business Mailing Address
First Line	:	8329 FREESTAR WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9454
Country	:	US
Telephone Number	:	719-357-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 LEHMAN DR STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-357-8989
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ KENDRA NICOLE FEWELL-HARTLING ” Practice Location

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