Provider Demographics
NPI:1033459763
Name:ROUND, KENDRA DIANE (CNP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:DIANE
Last Name:ROUND
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12877 E 213TH ST S
Mailing Address - Street 2:
Mailing Address - City:WEBBERS FALLS
Mailing Address - State:OK
Mailing Address - Zip Code:74470-6531
Mailing Address - Country:US
Mailing Address - Phone:918-441-4120
Mailing Address - Fax:
Practice Address - Street 1:615 S 32ND ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5012
Practice Address - Country:US
Practice Address - Phone:539-239-5240
Practice Address - Fax:539-239-5249
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily