Provider Demographics
NPI:1003398223
Name:NEILL, KENDAL (NP)
Entity Type:Individual
Prefix:MS
First Name:KENDAL
Middle Name:
Last Name:NEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENDAL
Other - Middle Name:MCAULEY
Other - Last Name:LEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-374-3526
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:1861 N PLEASANTS HWY # 101
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-8511
Practice Address - Country:US
Practice Address - Phone:681-612-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023248363LF0000X
WV115892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily