Provider Demographics
NPI:1043711211
Name:WHITE, KENDELL R (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENDELL
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 E GENERAL CAVAZOS BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7150
Mailing Address - Country:US
Mailing Address - Phone:361-592-3237
Mailing Address - Fax:
Practice Address - Street 1:700 FLOURNOY RD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4003
Practice Address - Country:US
Practice Address - Phone:361-664-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741510163WA2000X
TX1005297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator