Provider Demographics
NPI:1063835726
Name:LENCIONI, KENDALL K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:K
Last Name:LENCIONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:A
Other - Last Name:KILGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST BLDG 35
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-4009
Practice Address - Country:US
Practice Address - Phone:254-724-2663
Practice Address - Fax:254-724-9318
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332146501Medicaid
TX8981NHOtherBCBS
TX338053YKQHMedicare PIN