Provider Demographics
NPI:1043723174
Name:BROWN, KENDRISS LEIGH
Entity Type:Individual
Prefix:
First Name:KENDRISS
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1813
Mailing Address - Country:US
Mailing Address - Phone:580-928-8881
Mailing Address - Fax:580-928-8892
Practice Address - Street 1:1107 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-1813
Practice Address - Country:US
Practice Address - Phone:580-928-8881
Practice Address - Fax:580-928-8892
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist